Eric Joyce: When it comes to tackling terrorism and providing security in this country, does my right hon. Friend agree that ID cards have a part to play? Such things should be dealt with at the UK level, contrary to what that bunch diametrically opposite suggest? Their suggestion that they should be dealt with in Scotland are, at best, a dangerous distraction.

David Cairns: Neither I nor the Secretary of State have had any recent discussions with the Driving Standards Agency on test facilities for motorcyclists in Scotland.

David Cameron: As ever, the Prime Minister was about to thump 5.3 million of the poorest people in our country and he is scrabbling around with policy documents trying to find some excuses. As ever, there is no apology or admission of guilt, just a U-turn to try to save his skin. Does that climb-down not tell us all we need to know about this Government? It is always about politics, not policy. It is always about calculation, not conviction. It is always about his self-interest, not the national interest. Does the Prime Minister think that his reputation can ever recover?

Gordon Brown: Of course whenever jobs go in any particular part of the country, that is a matter to be regretted, but the important thing is that we are creating more new jobs, and creating them more quickly, than other countries. I just have to remind the hon. Gentleman that employment, according to the last figures, was at record levels—29.5 million people in work, 3 million more than in 1997—and that employment is up in every region and country of the United Kingdom. Our unemployment rate contrasts with a rate twice that in Germany and France and rising in America, and I think he should give some recognition to the fact that, even in difficult global times, we are continuing to create jobs and continuing to bring unemployment down.

Gordon Brown: If that is the case, the last thing the hon. Gentleman's party would want to do is to cut spending on transport, but that is exactly what the policy of that party is.

Mr. Speaker: We come to the main business, an Opposition day debate on family doctor services. I inform the House that I have selected the amendment in the name of the Prime Minister in both of today's debates.

Andrew Lansley: I beg to move,
	That this House supports the family doctor service, and recognises that it is the first point of contact for the majority of patients; further recognises the invaluable role that GPs have in the NHS; regrets the undermining and undervaluing of GPs by the Government; is concerned about the lack of empirical and clinical evidence for the establishment of polyclinics in every primary care trust; opposes the central imposition of polyclinics against local health needs and requirements; is further concerned about the delay in publishing evidence on the cost-effectiveness of walk-in centres; believes that patients should be able to choose the most convenient GP practice, whether close to home or work; calls for GPs to be given real budgets, incentives to make savings, the freedom to re-invest for their patients and the ability to innovate in contracts with healthcare providers; supports rewarding GPs who choose to provide services in deprived areas or areas of expanding population; and further supports the incorporation of patient-reported outcome measures into the Quality and Outcomes framework and the development of structures and services in general practice that are designed by GPs and primary care providers in response to patients' needs and choice.
	The purpose of the motion is straightforward. Through the new contract with general practitioners, the Government had a major opportunity to revive general practice in this country, and to rebase the NHS in patient-centred care and primary-care-led services. They failed to do that; by contrast, they have entered into a conflict with general practitioners that will undermine the service. The Government are taking an approach to the reconfiguration of primary care services that matches the dangers of the approach that they took to reconfiguration of secondary care. The progressive centralisation of services, the progressive undermining of access to care, the progressive undermining of the ability of clinicians across the NHS to determine what is best for their patients—those are the tragic consequences of the Government's failure to negotiate the GP contract successfully. Their mean-minded approach is not to negotiate in partnership with general practitioners, but to try to arrive at a solution that cuts costs and centralises services, while undermining the independence and clinical effectiveness of general practice.

Andrew Lansley: My hon. Friend raises an important point. In the course of the GP contract negotiations, the move towards a quality and outcomes framework had real potential, but as the National Audit Office report published earlier this year set out starkly, in order to try and secure agreement with general practitioners the Government took a large amount of that money out of the pot and put it into the minimum practice income guarantee. Over the intervening years, the system of remuneration for GPs has not impacted on list size and need as it should have done, which would have helped the most deprived areas, nor has it incentivised more doctors to come into those areas.
	The Government's and everyone else's purpose in starting to negotiate the new GP contract back in 2002 was to deal with problems of recruitment and retention. Recruitment in deprived areas was most difficult and it remains difficult. The Government's response should have been to deal with that problem, not to try and impose a solution everywhere else. By encouraging PCTs to offer new practices in under-doctored areas, the Government are saying now the same thing as they said in 2006 in the community White Paper, which we supported throughout. However, it is wholly wrong for them to seek to impose a polyclinic system in London and across the country, including in the most under-doctored areas, which would deprive many people of access to GP surgeries in their local neighbourhood.

Graham Stuart: My constituency is in a rural area outside of Hull, and it is rural areas that are particularly concerned about the proposals. They suffered when the Government tinkered with dentistry and my constituency has seen a major loss of dentistry services. The idea that the Secretary of State and the Government will now be tinkering with GP services horrifies my constituents.

Andrew Lansley: The hon. Gentleman has not been listening carefully, and he cannot have read the speech by my right hon. Friend the Member for Witney (Mr. Cameron) to the King's Fund on Monday. My right hon. Friend made it clear that we do not oppose change in general practice, but it must be driven by GPs themselves. [Hon. Members: "Why?] It must be driven by GPs in response to the needs of patients—it would be useful if the Secretary of State were to read the Opposition motion. The Government amendment does not provide any evidence that the Secretary of State sees any role for GPs or clinicians in interpreting the needs of patients, so I do not know how he thinks that patients' needs will be met.
	For the PCT to contract with additional practices to provide additional services in under-doctored areas is fine—we have always said that, and there is no reason why it should not go ahead. There is no reason why services that can be delivered more effectively in the community should not be delivered in the community, and there is no reason why GPs should not be able to commission services from a hospital or a community provider transferring services into the community. Sometimes, the hospital itself can provide those services, which certainly can involve diagnostic and treatment services. There will even be places where GP practices conclude that their premises are so poor that they need to come together in larger practices and premises. None of that causes me any problem at all.
	Because the hon. Member for Wolverhampton, South-West (Rob Marris) represents a constituency in Wolverhampton, perhaps he has not carefully examined the Darzi plan in London and what is currently being rolled out in every PCT across the country in a one-size-fits-all fashion, which is the creation of polyclinics. The Darzi plan in London makes it clear that a polyclinic is 25 GPs occupying 16,000 sq ft costing £800,000 a year with all the services in that place. Where are those polyclinics being put? Last week, I was in Bexley, where a polyclinic is being located on the site of Queen Mary's hospital, Sidcup. In Epsom, a polyclinic has been proposed for the site of St. Helier hospital. That is not taking care closer to home; that is centralising primary care, which will take it further away from the people whom it is meant to serve.

Tom Levitt: The hon. Gentleman may not have seen the briefing e-mailed in the past hour to Members by the NHS Confederation, the independent organisation representing NHS bodies. It cites the National Audit Office, which has said how successful the GP contract has been. It says that £500 million worth of savings on the back of the contract have been fed back into new services and how for the first time the contract relates patient outcomes and curing diseases to funding. All those things are improvements brought about by the GP contract and have been cited by the NHS Confederation. They fly in the face of what the hon. Gentleman is saying.

Alan Johnson: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"welcomes the fact that the Government is providing £250 million, in addition to existing GP services, for 152 new state-of-the-art GP-led health centres open from 8 a.m. to 8 p.m., seven days a week; notes that these will offer a wide range of health services including prebookable GP appointments and walk-in services; further notes that where patients previously had trouble seeing their GP or had to make numerous visits to a variety of health professionals, they will now be able to see a doctor more quickly, collect their prescriptions, get their eyes tested, have a variety of diagnostic tests or see a physiotherapist in the same building and at times convenient to the patient; further welcomes the additional centrally funded 100 GP practices to be located in the most deprived areas which will have a strong focus on promoting health and reducing inequalities; acknowledges the landmark agreement with GPs to extend surgery hours in evenings and on Saturdays and agrees that extended access will benefit hardworking families; further welcomes the extension of the role of pharmacies to be able to prescribe for and deal with minor ailments on the NHS, as well as promoting good health, supporting those with long-term conditions and preventing illnesses through additional screening and advice; recognises that the Government is on the side of patients; and agrees that extending access to GP services through extended hours and new GP health centres can have a real impact on health inequalities."
	I am delighted that the Conservatives have used this Opposition Day debate to allow us to highlight the investment that we are making in primary care and the measures that we are taking to give the public better access to the improved services that they require. Also, it is very good of the Conservatives to commemorate the 60th anniversary of the NHS by seeking to recreate the historical position of the Conservative party in 1948—opposed to better services for patients, defending instead the narrow vested interests of the more reactionary elements of the profession. I guess we could call it a sort of parliamentary version of the television programme, "Casualty 1907".
	Making sure that every citizen has access, free of charge, to a local GP if they are sick or worried about their health was the major premise on which the NHS was established, by a Labour Government in the face of fierce opposition from the Conservative party and its allies in the profession 60 years ago—it is really good to commemorate that in this anniversary year. We continue to support that premise. The role of the general practitioner as provider and commissioner of care, and as a strong advocate for their patients' health and well-being, is central to everything that we are doing. It is why we have made an unparalleled investment in GP services, from £3 billion in 1997 to £8 billion today. It is why there are now 5,318 more GPs and 4,471 more practice nurses than there were in 1997. It is why GPs now spend, on average, 50 per cent. more time with each patient than they did in the 1990s. And it is why we have increased the pay and reduced the hours of GPs, thus resolving a serious recruitment problem, while introducing a quality and outcomes framework regarded with admiration around the world, which helps to make GPs central to the care of people with long-term conditions, achieving documented improvements in health outcomes for conditions such as asthma and diabetes. The Tory motion describes all of that as "undermining and undervaluing...GPs". I can think of lots of professions that would love to be undermined and undervalued in such a way.

Alan Johnson: I believe that absolutely. GPs are fundamentally important to everything that happens in the NHS, and we have world-class primary care. That is why we have we have introduced those measures over the past 10 years—to bring in more investment and to attract more GPs, while ensuring that they are better rewarded and can spend more time with their patients.
	Let me deal with the rather pathetic attempt by the hon. Member for South Cambridgeshire (Mr. Lansley) to misrepresent our position. There is no national policy for replacing traditional GP surgeries with health centres or, indeed, polyclinics. There are no plans to herd GPs against their will, or the will of patients, into super-surgeries. We are not seeking to reduce the number of GP practices. I quote from the interim report of my noble Friend Lord Darzi—this also answers the intervention made by the hon. Member for Mid-Bedfordshire (Mrs. Dorries)— who said:
	"More than 80 per cent of NHS patient care takes place in primary care... Our registered GP list system is renowned internationally. Our primary care system co-ordinates care for patients in a way few other countries match. There are strong bonds between staff and their patients, families and carers."

Stewart Jackson: One always knows that the Labour party's arguments on health are vacuous when they are shroud-waving about the events of 60 years ago. In the week when the Government's own Back Benchers are revolting—even more than normal—over the abolition of the 10p tax band, is it not ironic that these proposals will potentially have the most significant impact on the oldest, the poorest, the sickest and those with the least voice in Government and policy-making? That is after a Labour Government of 11 years' standing.

Alan Johnson: Those definitions of what is a polyclinic and what is a health centre—

Charles Walker: As the Secretary of State knows, I campaigned in my constituency for an urgent care centre as part of the effort to ensure that hospital reconfiguration in the area did not leave my constituents short of services. My constituents want the reassurance of an urgent care centre, but they also want GP practices where there is a familiar, friendly face. Can the Secretary of State give an assurance that people will have a family doctor, who comes out on visits and be there for them?

Norman Lamb: My hon. Friend is absolutely right to highlight that. We should acknowledge, however, that measures of productivity can sometimes be misleading. If GPs are spending more time with their patients, that could be a good thing. This is certainly an issue that has been highlighted by the NAO, however.
	I want to deal specifically with the QOF system—the system that encourages GPs to do all sorts of things with preventive care. When the QOF system is reviewed, there is an evidence-gathering process to determine what should be incentivised in the reviewed system. On this occasion, a lot of work was done to develop ideas for addressing osteoporosis, including testing those who are most at risk, especially after the first fracture. A lot of work was also done on peripheral arterial disease and on heart failure. But what happened then? The thing that particularly frustrated GPs and many others is that the entire objective evidence-gathering process came to nothing because, at the last minute, the Government decided that the political imperative was to force through a one-size-fits-all extension of hours. That is the reality.
	An NHS Confederation briefing yesterday confirmed that the political imperative had involved increased hours and that all the evidence-based work—especially the work on osteoporosis—had gone of the window. That is what frustrates clinicians who care about their patients more than anything. A one-size-fits-all extension of hours has now been forced through. I fully support the case for extending hours and for making access more flexible. I am sure that everyone in this Chamber finds it difficult to see their GP—because of the hours we work and the fact that we work away from home—quite apart from those on low incomes who feel anxious about taking time off work and who would like to see a GP outside normal working hours.

Norman Lamb: Absolutely. All sorts of innovative things are being developed. In many practices, there is a commitment to speak to a patient by telephone on the same day, if an appointment cannot be arranged. Often, a telephone consultation is just what the patient needs. We should certainly support the use of e-mail and telephone consultations. Surely it should be for local commissioners to drive through decisions on increasing hours and making access more flexible in order to meet their local needs, rather than having a one-size-fits-all solution imposed from the centre.
	I want to return briefly to the question of osteoporosis. When I asked about the loss of that valuable work at the NHS Confederation briefing yesterday, I was given an indication that there would be an announcement shortly on ways—outside the QOF system—of encouraging GPs to test for osteoporosis. I understand that there was a written statement yesterday, although I have not seen it. I would welcome an intervention from the Secretary of State to tell us what might be about to happen. We understand that an announcement is imminent. Will he tell us, either now or through the Minister of State, the hon. Member for Exeter (Mr. Bradshaw) at the end of the debate, what is proposed? A lot of people who care a lot about this matter want that work to be incentivised, because it involves good, preventive health care.
	In an earlier intervention, I challenged the Secretary of State about the fact that the GP contract often ends up paying more to GPs in the leafy suburbs than it does to those in the most deprived communities. I want first to look at the minimum practice income guarantee. The  Health Service Journal has highlighted huge variations in payment to practices, regardless of the number of patients they serve or the needs of those patients. The article highlights two practices in Westminster, one of which happens to be based at Buckingham palace. That practice gets twice as much money as it ought to, because of the minimum practice income guarantee. The article states:
	"Under the allocation formula, the Buckingham Palace practice was due to get just £14,657 this year. But the guarantee added another £16,505. That left the practice with payments of £113 for each of its 276 needs-weighted patients, compared with the sample average of £63."
	How on earth can the Government justify that system? They are paying more money to practices—often in the more affluent communities—that do not need it. As the  Health Service Journal and many others have said, that money ought surely to be used to address health inequalities.
	Another issue highlighted by the  Health Service Journal is practices excluding patients under the QOF system. I hope that the Minister will be able to respond to this when he winds up the debate. Massive variations have been highlighted, with some practices excluding 10 times more patients than the national average. As I understand it, if patients can be excluded from the QOF target, it is easier to hit the target and to get the money. There is no evidence, however, that the problem is most serious in practices that genuinely find it difficult to approach patients because they are in hard-to-reach communities. For example, Tower Hamlets and the Heart of Birmingham primary care trusts have among the lowest levels of exclusions in the country. The point made by the  Health Service Journal is that this is a misapplication of millions of pounds of public money that ought to be going towards reducing health inequalities in some of the most deprived communities.
	Overall, the highest payments under the QOF system of incentivising GPs to undertake preventive health care, which is so important to reducing health care inequalities, go to practices in leafy suburbs. How on earth can the Government justify that system? My fear about the Conservative perspective is that if we simply give all the responsibility and power to GPs, that will ultimately do nothing to change such inequalities. Ultimately, if we are to ensure that money and funding is directed to the most disadvantaged communities, there is an essential role for strong commissioning.

Norman Lamb: I am encouraged to hear what the hon. Gentleman says—despite his very recent arrival in the Chamber, which I welcome. I have to say that in many parts of the country— [Interruption.] I hear a suggestion from a sedentary position that the hon. Gentleman has been saving lives, but I suspect that he was just having his lunch—[Hon. Members: "Ooh"]. I do not know how much the hon. Gentleman talks to his GP colleagues around the country, but what he referred to is simply not happening in many parts of the country, where many GPs are becoming very disillusioned as a result.
	I want to say a few words about the Conservatives' over-reliance on the GP to ensure that that whole health system works effectively and in the patient's interests. The Conservative spokesman acknowledged, in response to an earlier intervention, the importance of recognising the potential for conflicts of interest, but that is absent from the Conservative motion and from most of their pronouncements. There are real concerns, including among many GPs, about potential conflicts of interest, and it cannot be said that GPs will always act in the patient's interests. One example can be seen in what I said earlier about exclusions under the QOF system. In my view, it is a dangerous game simply to believe that GPs can run the whole system. They are absolutely central to it, but their role has to be combined with strong, effective commissioning.
	This afternoon's discussion on the difference between a polyclinic and a health centre was interesting. As I said at the NHS Confederation briefing yesterday, the honest truth is that the difference amounts only to a rebadging. The Government were calling these bodies polyclinics, but they got such a bad name through what GPs and others said about them that we now call them something else. When I asked what a GP-led health centre was all about, all the things that I was told they would contain sounded very much like a polyclinic. These are, at the very least, embryonic polyclinics.

John Pugh: There is a lack of semantic clarity about the issue, as we have already seen in our debate, but one would expect the Government to know where polyclinics were. When I asked the Secretary of State
	"how many NHS polyclinics there are in England; and where each is situated",
	I received the reply:
	"The Department does not collect information about services commissioned locally by primary care trusts"—[ Official Report, 29 February 2008; Vol. 472, c. 1982W.]
	That was news to all of us; as well as not knowing what they are, it seems that we do not know where they are.

Norman Lamb: I am grateful to the Conservative spokesman for that information. It is of some concern that the chair of the Select Committee on Health does not appear to know what the Government policy is.
	There seems to be a conflict in the Government's approach to the NHS. They talk of empowering patients and responding to what they really want, but when it comes to the crunch they always opt for a model imposed from the centre.

Nadine Dorries: The hon. Gentleman makes a number of points. The only reason that we see pressures on accident and emergency services at the moment is that cottage hospitals and community hospitals are being closed down. As for 12-hour practices, I have had no letters in my postbag on that subject and no constituents coming to my surgeries to say, "I wish my doctors' surgery was open for 12 hours a day." It is unreasonable to expect GP surgeries to open for 12 hours a day, if we have good local facilities provided by the PCT.
	Let me give an example to the hon. Gentleman. A GP recently told me of a PCT manager who got very stroppy with him in his surgery, because the GP had seen a patient who had been out of hospital for 10 days after a post-partum haemorrhage in hospital, and who went to his surgery and complained of chest pains and a pain in the leg. She was a very poorly lady. The GP immediately thought that that could be a pulmonary embolism, did the right thing and sent her to hospital. He was then criticised by the PCT for doing so, when any GP anywhere would do the same in such circumstances, polyclinic or no polyclinic. When a GP sees a patient with acute needs, such as chest pains, he saves the PCT that £3,000 admission fee, because many GPs will diagnose and treat in their surgery as far as possible before sending a patient to hospital.
	I do not see polyclinics as filling a need because I do not think that the need is there. GPs provide an excellent service; they save PCTs a huge amount of money; and they are incredibly cost-effective. Patients like the service. They like having a local GP. GPs enjoy building up a good relationship with their patients, so why, if it is not broken, do we need to fix it? That is what I do not understand.
	In areas such as Macclesfield, where we need such services, we have provided them. What is the image of the polyclinic? Why are we imposing such a service on to communities? Why are we making it more difficult for patients? Why are we imposing something that doctors do not want?
	On the point about blood counts, can anyone show me a GP who does not take blood tests and send them on to a hospital lab? A GP who does not do that in his practice should not be a GP. Many GPs provide that service—I have never heard of one who does not. Can anyone show me a GP who does not refer on for radiography or who does not provide the test? They have those services at their fingertips if they need them.

Richard Taylor: I have absolutely no objection to siting these facilities, whatever they are called, in areas where they are needed. I just want to be able to tell my local PCT that it is up to it to decide what is best for the local area.
	My real worry about polyclinics is that they could open the door to commercialisation. The hon. Member for St. Ives (Andrew George) touched on that problem in an earlier intervention, but I want to look at it in a bit more detail. People often ask what all the fuss is about, and a letter in my local paper, the  Worcester News, carried the headline "Just what point are GPs trying to make?" The letter stated:
	"Let me try to understand. They are, apparently, totally opposed to the "privatisation" of general practice—yet, of course, the private sector is precisely where they themselves work and earn their crust!"
	I was rather disappointed by a document distributed at yesterday's NHS Confederation briefing. Headed "Privatisation and reduced quality", it stated:
	"There is concern that opening up contracts to the private sector will have an adverse impact on quality and that there is not a level playing field between the private sector and incumbent GPs. However, this seems to ignore the fact that GP practices are independent for-profit contractors already."
	The most effective response to that approach comes from the pressure group "Keep Our NHS Public". It is not a rabid, left-wing group: its members are highly dedicated professionals who are passionate supporters of the NHS, through and through, and I shall paraphrase some of the points that they make.
	The group accepts that GPs are independent contractors, but asserts that they are crucially different from the large corporations that stand ready to compete for the provision of health services. It says that GPs know their patients and are driven by local priorities—exactly what the Secretary of State said when he acknowledged the value of the relationship between GPs and local families. The group believes that profits for shareholders drive the private corporations, and that those corporations will decide which patients to treat and which services to offer.
	The pressure group believes that professional judgment can be overridden by company policy, and that governance and the monitoring of standards of care could be impeded by commercial confidentiality. It also says that the skill mix may be downgraded, and that NHS pay, conditions of service and pensions might not be retained. I believe that such warnings about the dangers of commercialisation need to be taken very seriously, and in that regard I commend to Ministers two seminal articles that have been published recently.
	The first article appeared in the  British Medical Journal, and it looked at the US experience of competition in the health care system. It said that the US has long combined public funding with private health care management and delivery. It noted that extensive research had found that the US' for-profit health institutions provide inferior care at inflated prices, and that the US experience shows that market mechanisms undermine medical institutions that are unable—or unwilling—to tailor care to profitability. Finally, the article said that the poor performance of US health care is directly attributable to reliance on market mechanisms and for-profit firms, and that it should serve to warn other nations from following that path.
	The second article was published in the  New England Journal of Medicine, which is highly respected in this country. It states:
	"The extreme failure of the US to contain medical costs results primarily from our unique, pervasive commercialisation ...Medicine...does not lend itself to market discipline."
	The article describes in detail the cost-containment tactics and false economies that commercial organisations plan, and it also looks at revenue-maximisation strategies, the concentration on lucrative procedures and the selection of risk. It even pays a tribute to the British system, saying:
	"When the British NHS faced a shortage of primary care doctors, it adjusted pay schedules and added incentives for high-quality care, and the shortage diminished. Our commercialised system seems incapable of producing that result."
	The article ends with the observation:
	"Sometimes we Americans do the right thing only after exhausting all other alternatives. It remains to be seen how much exhaustion the health care system will suffer before we turn to national health insurance."
	That worry has been reinforced by at least one whistleblower, who was reported in  The Guardian on 9 April. I have seen the papers involved, which I think that he probably sent to all members of the Health Committee. They were very long and complicated, so I do not blame any colleague who has not read them through, but the man who provided them has seen the lengths to which organisations that want to break into the market will go to enhance profits. I am reminded of the recent revelations about how a drug manufacturer went to unethical lengths to prolong the life of one of its proprietary drugs that was long out of patent.
	I have the marvellous privilege of being able to choose how to vote at the end of this debate, but my problem is that I do not know whether to support the motion or the amendment. That terrible quandary arises because I am not completely sure that the NHS as I have known it for years will be entirely safe under either of the two main parties. I do not yet know how I shall decide to vote, but my voting record would suffer if I did not support either proposition.
	I welcome much of what the Government have done for the NHS. I appreciate the extra money that they have provided and the way that they have handled the service, but I hope that they will look very seriously at the warnings that I have repeated about the dangers of opening up family doctor services to commercialisation.
	However, I am also worried about the Conservatives. We all know the proverb about how difficult it is for a leopard to change its spots, but it has a corollary—that even when a leopard does change its spots, it remains rather proud of having had them. The changes to the NHS made by the previous Tory Government included the introduction of market forces, the purchaser-provider split and the private finance initiative. I therefore cannot quite accept that any future Conservative Government would oppose the commercialisation that I strongly believe is not welcome in general practice.

Howard Stoate: First, may I apologise to you, Mr. Deputy Speaker, for not being in my place at the start of the debate? I had a meeting with the Prime Minister, but one of the issues that I raised with him was the proposal on polyclinics, so at least that was relevant to this discussion.
	As many hon. Members will know, I am a practising GP, something that I hope will enable me to make a constructive contribution. It will be of no surprise to the House if I say that I speak to an awful lot of GPs around the country. Many of them are concerned about what the polyclinic model might lead to, and worried about how it might affect their practices and patients. I therefore think that it will help the House if I set out what I see as the vision for this type of health care.
	I envisage a mechanism whereby people can be treated far closer to their own homes, with far less reliance on public transport, far shorter queues and much less reliance on accident and emergency departments, which are often inappropriate places for people to go with many health care needs. They are often not seen by the most appropriate person in the department, and in many cases it is not the nicest place to be. A and E departments simply become clogged up, which often gets in the way of the serious, life-saving work that they need to do. The last thing that they need is a group of patients coming to the A and E who would be far more appropriately treated by their GP practice, district nurse or pharmacist, in a setting that would be far better for their health care.
	It is important to set out exactly what the polyclinic model is intended to do. The hon. Member for Mid-Bedfordshire (Mrs. Dorries) said that there is nothing that a polyclinic can provide that cannot be provided by a GP service. I am sorry that she is not currently in her place. The fact is that a polyclinic or such a model could offer a huge number of services that currently cannot be made available in GP services. An obvious example is X-rays. The hon. Member for South Cambridgeshire (Mr. Lansley) made the point that ECGs can be sent online. Of course they can, and of course blood tests can be taken in GP practices. However, it is much more difficult for a GP practice to have an X-ray or ultrasound department with the necessary scanning equipment and range of health care professionals. That is well beyond the scope of current general practice, and we need a radically new way of deciding how those facilities should be produced.
	When I ask my patients what they want, they say that they want to be treated as near to their homes as possible, hopefully by people whom they know, trust and have had dealings with before. They do not want to go and sit in a crowded, noisy hospital among patients who clearly have far greater health needs and therefore should obviously take priority. The polyclinic model is a good example of how we can transform patient experience.
	Another obvious example of why the system might work is that it is currently estimated that every time somebody walks into A and E, it costs the health service about £150. A GP consultation costs about £20, so we can immediately see that anybody who attends their GP surgery instead of going to A and E will lead to a dramatic saving in health care expenditure, which could therefore be targeted better than by spending it on A and E. Obviously a polyclinic would have extra fixed costs and there would be other services to consider, but it would still mean a significant cost saving compared with people going to A and E, and it would therefore leave far more money for investment in NHS services and for better use in patient care.
	The NHS has moved on. Clinical practice is evolving all the time, and patients' expectations are changing. When I first entered general practice, people almost always had surgery as in-patients in hospital. They often stayed in hospital for several days, or even weeks. Now, 70 to 80 per cent. of all surgery is day surgery. The idea of relying on large, impersonal hospitals is a model that has outgrown its usefulness, and we need to move on to a much more flexible and modern approach. I believe that polyclinics, rather than diminish the range of services and choice, will increase it.
	The myth that goes around that if a polyclinic is set up, patients will no longer have a choice of GP, is clearly rubbish. Under the patient choice directive, patients will be able to request a specific GP. Provided that that GP is on duty, that it is reasonable and that he or she has the available appointments, the patient will be able to specify that GP. It does not have to be impersonal. In fact, the model that I read out in an earlier intervention will, in many cases, be based around existing practices, which could be significantly extended or developed to add the extra services that are not currently available, albeit with extra funding and resourcing.
	Another advantage of polyclinics is that they will allow GPs, acute specialists and other health professionals such as pharmacists to work together for the first time. General practice can often be isolating, and in small, isolated practices it is often quite difficult to have the mix of colleagues and clinical expertise that is required for personal and professional development.
	I am aware that time is pressing on, so I do not wish to go on too long, but I wish briefly to quote Mr. Anthony McKeever, the chief executive of the care trust in Bexley, where my practice is situated. I wrote to him recently to ask what the PCT's model of polyclinics was. He stated:
	"We do not intend to create polyclinics on the assumption that 'one size would fit all'...A couple of local practices have indicated that they would like actively to explore the possibilities of providing a more integrated care landscape...So, there will be plenty of opportunity to avoid the pitfalls which some anticipate...Certainly, however, the GPs I spoke to direct recognised that the development of primary care 'hubs' or polyclinics could be achieved without damaging and unintended consequences."
	As far as I can see, that is the chief executive of a PCT being sensible and pragmatic and understanding that flexibility is perfectly acceptable under the Government's plans, and who actively wishes to work with local GP practices to ensure that what actually happens is a huge improvement in patient care outcomes. Hopefully, that is what we are all aiming for.

Stewart Jackson: It is a pleasure to follow the hon. Member for Dartford (Dr. Stoate), with whom I served on the Select Committee on Health.
	I should like to make a few general points about family doctor services. That is the subject of the debate; it is not just about health centres and polyclinics. At the kernel of the debate is a question of honesty and integrity on the part of the Government. I do not believe that they have made the case transparently and openly for a Kaiser Permanente, California model of private sector health provision. They know full well that were they to make that case, they would not get it past their own parliamentary party, the health sector trade unions or other health care professionals. There may be merit in their model, but at the moment we are not having an honest debate about it. It is incumbent upon the Government to put their cards on the table and make the case for polyclinics or health centres.
	It is ironic that the Secretary of State was in crowing mood. As I said earlier, we always see the vacuity of the Labour party's record and arguments on the health sector when it has to go back 60 years, to historic documents about what was or was not said by general practitioners and medical practitioners in 1947. The fact is that this Government have presided over a doubling of expenditure on the health service but barely any change in outputs and the impact on patients. Their work force planning was described in the Select Committee's report last year as "disastrous." The right hon. Member for Rother Valley (Mr. Barron) was noticeably shy in not sharing that with the House.
	The Government have presided over a health service in which one is more likely to die of a hospital-acquired infection than, for instance, in a road traffic accident. They will have spent approximately £100 billion on the health service, and we will not take any lectures from a Government who, for example, have increased GP salaries by 50 per cent. for less work. I do not blame the general practitioners for that; it is this Government's cack-handed mismanagement that has resulted in that situation.
	I well remember that the then Prime Minister came to Peterborough in April 2000 to open the walk-in centre in Midgate, in the city centre. Such centres were then the great thing, the next big thing of Labour's Maoist onward march of health reform. They were going to solve all the problems and take up the slack in the primary care sector. Of course, they are not in fashion now, so we have even more change.
	My opposition to the scheme is not a knee-jerk opposition to change. Dare I say it, I am quite Fabian in my approach—I believe in the inevitability of gradualism. In such a big organisation, there will always be change, but I object to the top-down approach of the change and the fact that there is no real autonomy, authority or democracy in respect of general practitioners, health care professionals, nurses, managers, elected councillors and others at local level. The change is being imposed. That is to be regretted—a point made by Members across the House.
	General practitioners in particular need to be properly consulted; they need buy-in to the new health centres or polyclinics. It is no good the Secretary of State, in his rather uncharacteristically sneering remarks, belittling the work of GPs, who are the most trusted health care professionals in the UK—perhaps the only point in my speech with which the hon. Member for Dartford will agree. It ill behoves the Secretary of State to take that confrontational tone, and it is no wonder that such a significant number of GPs are not predisposed to vote Labour at the next general election.
	I want to give the House a slight history lesson about primary care in the city of Peterborough. The city pioneered collaboration between adult social care and primary care, which the Liberal Democrat spokesman, the hon. Member for North Norfolk (Norman Lamb), described as an exemplar for the country. If I may, briefly, be positive, one of the only aspects of the Government's health policy with which I agree was that they listened to us about Peterborough's primary care reorganisation in 2005. We in Peterborough said that as we had pioneered collaboration between adult social care and primary care it would be ludicrous to throw it away in an unpopular and uncalled-for reorganisation. The Government listened, and the former Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), threw out the plans.
	There were other reasons why we insisted that we should have a city-wide health care body or primary care trust. We in Peterborough have specific health needs and health inequalities. Even in a relatively small area such as Cambridgeshire there is a great gulf between the needs of my constituents and, for instance, those in a relatively wealthy constituency such as Cambridge. We have issues around asthma, chronic obstructive pulmonary disorder, diabetes and heart disease. We have a large ethnic minority population who are predisposed to some chronic conditions. We felt that to be subsumed into a greater Cambridgeshire PCT was not appropriate—the fact that the trust was approximately £30 million in deficit at the time concentrated our minds somewhat, too. The Government listened, and we went forward.
	I pay tribute to the PCT in Peterborough and the professionals who work in the organisation, especially Angela Bailey, the chief executive. However, when I read the proposals and listen to the Secretary of State, I am astonished that a Government who exult in the fact that the NHS is 60 years old and that they were responsible for founding the national health service could really be presiding over changes that would give the sickest, the very oldest, the very youngest and the poorest—the least able to speak up for themselves—a second-class primary health care system. As I said earlier, I cannot believe that of a Government who seem to be having a nervous breakdown in their interaction with those who should be their core supporters. We know that the Labour party has always had a rather sanctimonious, smug attitude—only Labour cares about public health, the poorest people in our society and the health service. Of course, that has never, ever been true.

Stewart Jackson: I am grateful to my hon. Friend for making the pertinent point, alluding to his constituency, that where we trust NHS professionals and give them authority, autonomy and budgets, they will work for their benefit and the benefit of patients and the whole community. We can see an example of that co-operative work in the primary care sector in Cheshire, particularly in Macclesfield. I pay tribute to my hon. Friend for his role in producing that outcome.
	As of March 2009, a polyclinic or health centre, or whatever it is to be called, will be foisted on my constituents in Peterborough, with only partial lip service to democracy—the gloss of democracy—via the city council health overview and scrutiny committee. What is the strange beast that will be foisted on us? Open 12 hours a day, seven days a week, it will apparently provide a one-stop, multidisciplinary medical assessment, diagnosis and treatment facility, supposedly located in a deprived area of the city. All fine and dandy in principle, but what does one-stop medicine actually mean? Where will the doctors to staff the polyclinic come from? No established doctor who has his or her own family practice will want to give it up to work at a polyclinic. Does that mean that less experienced and capable staff will be recruited? I hope not. When we board an aeroplane we hope it will be flown by a pilot, not an air stewardess. I hope that when my constituents go to a polyclinic they will receive the highest possible standard of primary care from clinicians and NHS professionals.
	We have already seen shortages across the country—for example, of fully trained radiographers, as my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) said, specialist nurses and hospital doctors. What about X-rays, scans and blood tests? Will there be consultants on site to oversee such work? If so, who will cover their work at Peterborough district hospital and Edith Cavell hospital? What are the resource implications?
	Will polyclinics deal only with straightforward cases, such as the young, the wealthy and the only occasionally poorly—Tarquin and Jocasta popping down in their 4x4 before they go off on a business trip? Will polyclinics treat only the so-called worrying well? That may be the case. What about the very old, the poor and people with chronic conditions, such as chronic mental health issues? Will they be welcome at the polyclinic? I am not entirely convinced.
	What will be the future of the family doctor service in my constituency? Will those services go the way of local shops and pharmacies? Mention was made earlier of the impact of the 2005 regulations on small pharmacies, which are closing at an alarming rate, giving way to the provision of pharmaceutical services in large supermarkets such as Sainsbury's and Asda. Will those services go the way of NHS dental surgeries and of post offices? We know of the Government's lamentable record of duplicity about post office closures over a number of months and years.
	The Department of Health has promised more money for polyclinics, but will it be from existing, struggling NHS local budgets? I beg the indulgence of the House while I make my next point—one with which my hon. Friend the Member for Boston and Skegness (Mark Simmonds) will have some sympathy. We have had a huge influx of EU migration in Peterborough that has put massive strain on surgeries across the city, notably the surgery of Drs. Modha and Modha at Thistlemoor road, New England, and Dr. Prasad's surgery at the Westwood clinic. They are straining under the weight of inward migration from the EU. Will that be taken into account in the national template forced on local PCTs? No one in Peterborough has voted to end the relationship between patients and their local, trusted and—mostly—friendly general practitioners for the sake of those super-surgeries.
	We should be opening more family practitioner surgeries in the poorest areas of my constituency. We should not be centralising and putting everything in one place—a place that people who have travel and transportation problems as a result of their illnesses and medical conditions may find it difficult to reach. As always happens under this Government, there will probably end up being a great fanfare and lots of money spent, but at the end of the day there will be depersonalised services, dumbed-down care and a system without comprehensive budgeting, risk assessment or proper consultation.

Stewart Jackson: Labour Members of Parliament, who are in a weird parallel universe with the Prime Minister, voted against a Conservative motion on post offices in the Lobby, and then ran hotfoot to their constituencies to address public meetings, in which they said how hard they were working to keep post offices open, having issued press releases and put them on their websites. I am an old cynic, but I foresee occasions when my Labour opponent will be fighting tooth and claw to protect surgeries that his own Government have led to be closed.
	My admiration for local NHS staff is well-known, and we are fortunate to have good managers in our area, but my job as a Member of Parliament is to stick up for the people in my constituency who do not have a voice, and to ask awkward questions. I will continue to ask those questions until we have full, honest and transparent answers from the Government on polyclinics, and until we concentrate on the really important issues—on making the whole of our communities better—instead of on gimmicks that will lead to disaster.

Kevin Barron: I declare an interest: I am a lay member of the General Medical Council. First, I want to reply to a comment made by the hon. Member for Wyre Forest (Dr. Taylor) about clinical judgment being superseded by the needs of a company—I think that he was quoting from the NHS campaign group, Keep Our NHS Public. In all my years on the GMC, that has not happened. People who work in the independent sector come before the GMC from time to time, but I have never met anyone in the medical profession who felt that they would have to do something that was against their clinical judgment; that would be wholly wrong and unprofessional. We may argue about one pharmaceutical prescription as opposed to another, but I do not see any proposals that would endanger the patient.
	The hon. Member for Peterborough (Mr. Jackson) was a member of the Select Committee on Health a few months ago. We criticised the national health service, and therefore the Government, on work force planning. That is absolutely right. As most people in the national health service would agree, work force planning has been dysfunctional for a long time now. That situation is beginning to get a little bit better—I am pleased about that, and I hope that the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), is, too—but it in no way threatens family doctor services.
	I point out to my hon. Friend the Minister that family doctor services have been the backbone of the NHS for the vast majority of our constituents since 1948, and will remain so. It is true to say that those services are not always the first port of call. The hon. Member for Romsey (Sandra Gidley) would probably jump up and tell us that our constituents' first port of call for health care help and professional advice is the local pharmacist, and not the local GP; that will remain the case. The vast majority of doctors who work in family care services are committed to their flock—their patients in the community where they practise. I have no doubt about that, and I do not feel that they are under threat in any way.
	Let me say why I do not support the Opposition motion and why I support the Government amendment. In their changes, the Government are investing an extra £250 million to establish more than 250 new primary care services, which will include both GP-run health centres and GP practices. Some 113 of them will be established in some of the most deprived communities in the country which have historically been under-doctored. There will be 152 new state-of-the-art GP-led health centres, which will be open between 8 am and 8 pm, seven days a week. One such structure will be built in a constituency that neighbours mine, but it will serve my constituents well. Those health centres will offer a wide range of health services, including pre-bookable GP appointments and walk-in services for registered and non-registered patients, and a range of specialist services.
	I had discussions last September with the local foundation trust. It will bid to provide some of the services that will be offered in the new primary care centre, as we will call it in Rotherham. Those services may not be offered in the district general hospital. Particularly for those who do not have their own transport, it is a lot easier to go to the town centre by bus than it is to get to the local hospital, so it will be a great advantage to urban Rotherham to have that facility, which will be open seven days a week, 12 hours a day.

Kevin Barron: I agree. The question posed in the motion, and asked by the hon. Member for South Cambridgeshire (Mr. Lansley), is: what about walk-in centres? Our walk-in centre in Rotherham will close. It is based in a pretty old building that used to be a hospital. It is not an acute hospital now, although services such as podiatry are based there. People will instead go to the new primary health care centre—we are not calling it a polyclinic—that will be built in Rotherham. I had an e-mail from the primary care trust earlier this week saying that there will be two new GP practices in there. Those practices will not be transferred; they will be new. It also said that local GPs who want to bid for that contract will have the right to do so. Family doctor services could even expand if they are successful in obtaining an NHS contract to provide that type of service in the Rotherham primary care centre. We should recognise that no matter who runs such centres, those are national health service contracts designed to provide better services for our constituents.

Nicholas Winterton: I am grateful to the current Chairman of the Health Committee, which I had the honour to chair in the past, for giving way. Will he say to the House that polyclinics should not be forced upon areas where there is already adequate cover by way of out-of-hours services, staffed by local GPs—in my case, as I said in an earlier intervention, at the district general hospital? In Macclesfield all the GPs services have come together in an excellent super-surgery, where they operate separately as individual practices, which is so important to people. Is it not right that a polyclinic should not be forced on areas where there is already adequate coverage?

Kevin Barron: I am no expert on the hon. Gentleman's constituency but, as was said earlier, and not by me, there is and should be flexibility. It might be the local community hospital that delivers the service. That might be a structural matter. Years ago I visited some of the community hospitals outside my constituency; they were so old that they were hardly suitable for the 20th century, let alone the 21st. A decision will have to be taken at local level about how and where the service is provided.
	The motion states that the Opposition are against the imposition of polyclinics
	"against local health needs and requirements".
	What is the evidence? There is little evidence. Most decision making in the national health service could hardly be called evidence-based. On the contrary, it is often a matter of wetting one's finger, putting it up in the air and seeing which way the wind is blowing. This is the first time I have said that, but it is a true representation of how decisions have been taken for the past 59 years.
	The hon. Member for Peterborough (Mr. Jackson) mentioned Kaiser Permanente in California. Studies in the US have shown that where there are more primary care practitioners on the ground—not just GPs, but other health professionals as well—there are healthier communities. That may be an international finding and it may not be specific to east Yorkshire or South Yorkshire, but in general, it is likely that by expanding the number of primary care health professionals, not just GPs, better health care will result for the people in that area.
	The Opposition motion opposing the imposition of polyclinics
	"against local health needs and requirements"
	echoes the BMA brief, which states:
	"The BMA acknowledges that there may be a case for establishing a polyclinic in some very specific circumstances, such as where local patients and clinicians agree on a proven need in their area."
	That has been the subject of debate for 59 years in the national health service. Who takes that decision? How is the need measured?
	I represent an area with very high disease burdens. Fifteen years ago it had the highest patient:GP ratios in England and Wales. It is a little less now because of the action that this Government have taken, but are GPs flooding into South Yorkshire to come and work alongside the hard-working GPs dealing with massive problems at every surgery, because of the difficulties that we have, sadly, with smoking, drinking, eating and the scars that industry has left on individuals? If it were not for the Government changing the GP contract, we would have the same patient:GP ratios that we had previously.
	I should like to know—I say this to those on both Front Benches and to everyone in the debate—how we measure the needs of communities, if not by looking at the disease burden that they carry and taking the action proposed by the Government to put GP services into those communities? What other way of measuring need is there? I do not know another way. If it is true that in America more primary health care professionals lead to healthier communities, the Government's proposals should be endorsed by everybody, including the medical profession.
	Most of the Government's proposals in recent months relating to family doctor services have been grudgingly accepted. One doctor turned up at my constituency surgery to discuss the issue of doctors' hours, which went to ballot. The rest of them get on with doing a very hard job under difficult circumstances because of the size of their patient list and the disease burden that those patients carry. The BMA badly misrepresents GPs, as it did on the issue of extending practice opening by a few hours in the evening and on Saturday. The BMA and the GPs within it are badly led.
	One of my constituents sent me a leaflet picked up in a neighbouring constituency. Headed "Your family doctor service is under threat", it states:
	"If we don't agree to this, the government has threatened to take this money away from patient services anyway and give it to local Primary Care Trusts (PCT) to fund large town centre 'Superclinics', probably run by private companies for profit. This could be the first stage in privatising all family doctor services and then the whole NHS."
	We heard the hon. Member for Wyre Forest say that family doctor services are not and never have been run by the state. They are private businesses that are run under contract to the state.
	The hon. Member for Peterborough said that the Labour party always harks back to what happened 60 years ago when the national health service was created. It was on precisely the matter of GPs that Nye Bevan fell out with many people, and I suspect with those on the Labour Benches in the Chamber, although at the time the Chamber had been knocked down for a few years. It was agreed that GPs would not work for the state, although there are some in my constituency and in all other constituencies who work on a salary, and thank goodness they do. That has enabled us to bring down the patient:GP ratios a little.
	I have had only two letters on the matter, but leaflets like the one that I quoted are outrageous and do the profession terrible harm. A similar one was being circulated in neighbouring Doncaster. I am pleased that my right hon. Friend the Secretary of State stuck to his guns and said that, under the new contract and its treatment of doctors, it is reasonable for us to expect that doctors' surgeries should open on a Saturday morning. They always used to do so when I worked in industry, before I came to the House, and sometimes in the evening, to make it easier for people to attend.
	I am dismayed at the lack of professional leadership that the BMA provides to general practitioners. Dr. Laurence Buckman wrote an article on family service access. I have met him a couple of times and he is obviously an independent-minded person. In the "Royal College of GP News" in February 2008, he is quoted as saying:
	"If there is a boat I'll rock it...I don't shy away from confrontation—people need to hear our point of view. I first got involved with the BMA because I was an angry young man with something to say and I still feel the same way now."
	The last trade union leader to say that was Arthur Scargill, and look what happened to the coal mines. I do not think that the GP surgeries in the Rother valley will suffer the same fate as the coal mines, but that is not good, sensible and responsible leadership. Dr. Buckman went on to say:
	"Politicians aren't primarily interested in the health service; they're out for what will be good for themselves and their constituents."
	That is absolutely right. After 59 years of being dictated to by those who work in the health service as opposed to those who need to use it, I could not agree more. If this man was representing me, I should be going along to the next branch meeting.

Kevin Barron: I do not know the detail of his QOF points, but the Select Committee will be looking at QOF points later in the year in relation to health inequality. I expect that the debate will be ongoing for a long time, but I come back to how we can assess local health needs other than by measuring the disease burden in communities to determine whether we need more health practitioners, perhaps for preventive reasons or to enable people to be seen more quickly. How do we measure such needs other than by taking such action? Rather than destabilising or closing local GP surgeries, it will give them the opportunity to bid for and to work in the new centre in Rotherham.
	The Government seek to take the health service to those who need it so that they can make better use of it than they can at the moment because there are fewer doctors in their areas than there should be and those who are there are working hard with a difficult patient workload. The sooner this is sorted out collectively—it does not look as though we will reach a decision on the matter today—the better it will be for the NHS and our constituents.

Mark Simmonds: Sadly, the Secretary of State is not in his place. Unusually for him, the issue has clearly rattled him. He did not set out how he will explain to his constituents that the PCT that covers his constituency has admitted that it sees the imposition of a polyclinic as an opportunity to reconfigure GP services, thereby possibly closing existing practitioners. He did not support the family GP, and, interestingly enough, he did not defend the imposition of health care centres or polyclinics.
	In response to my intervention—it will be interesting to see whether he confirms this later—he stated that primary care trusts do not have to have a polyclinic or a GP-led health centre and can therefore use the resources that would have been allocated for other, locally driven services. We will wait and see whether he substantiates that point outside this House.
	The hon. Member for North Norfolk (Norman Lamb) once again explained how his party plans to politicise PCTs' expenditure decisions by direct, local political interference. He rightly highlighted low morale among GPs and the need to review the quality assessment framework. He was also right to highlight the importance of preventive health care and the link to health inequalities. We need greater emphasis on public health. The PCTs with the greatest level of deprivation often spend the least resources on public health.
	My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) expressed her genuine concerns on behalf of GPs in Bedfordshire and about the imposition of GP-led health care centres in her constituency based on the potential breakdown of the GP-patient relationship. She rightly highlighted the importance of decisions being made locally in Bedfordshire in response to local community needs and questioned the logic behind the imposition of such schemes against local wishes. It will be interesting to hear what the Minister says in response to her points.
	The hon. Member for Wyre Forest (Dr. Taylor) is a distinguished and knowledgeable Member of this House who always makes an interesting contribution to health debates, and today was no exception. He was correct to highlight the fact that GPs are independent contractors, but it must be right to harness the independent sector to drive improvements in the provision of health care, which should always take place through the prism of patients rather than through the prism of the delivery mechanism. It is right that the Opposition support any willing provider. I can give the hon. Gentleman the assurance that he seeks: the Opposition passionately believe that the NHS should be free at the point of delivery, and we are completely committed to the objectives and ethos of the NHS.
	As the House knows, the hon. Member for Dartford (Dr. Stoate) is a practising general practitioner, and he is extremely knowledgeable about those matters. However, I wish he would use that expertise and knowledge constructively rather than unconditionally supporting Health Ministers in whatever they are trying to do, regardless of whether those things are in patients' interests. He is right to highlight the additional pressure on accident and emergency departments, which was initially a direct result of the Government contracting both extended and out-of-hours services under the GP contract, which came into operation in 2004. Before I move on, I also want to know whether the hon. Member for Dartford is one of the 3 per cent. of GPs who are happy with the Government's handling of the NHS, or whether he is part of the 97 per cent.
	The right hon. Member for Rother Valley (Mr. Barron) is a distinguished Chairman of the Health Committee, and his contributions are always thoughtful and serious. He was right to say that GPs are the backbone of the NHS and that less well-represented areas often face serious problems with health inequalities. There is no political difference between the three main political parties that that needs to be addressed. However, the Government amendment deliberately obfuscates and confuses two particular central Government initiatives, which need to be separated and debated independently. As the right hon. Gentleman said, patients demand greater access, and we support that demand where it is necessary. However, we also need to consider why it is there. The reason Members of Parliament found significant constituency concern when the contract was changed was that patients found that access to their GPs was not as it had been before. That concern has died down because patients have found a way of circumventing the problem, by going to accident and emergency and putting additional pressure on ambulance trusts. We need to make sure that the decision in respect of services used is with the patient, not with central Government.
	We then heard from my hon. Friend the Member for Wellingborough (Mr. Bone), who made a significant contribution based on experience in Northamptonshire. He was absolutely right to highlight the possible loss of the relationship between GPs and their patients.
	I missed out my hon. Friend the Member for Peterborough (Mr. Jackson), but I should not have done—he is an assiduous and tireless defender of his constituency's interests. He was right to highlight the Government's failure to deliver improvements, particularly in the context of the significant amount of taxpayers' money that has been invested in the national health service. He was also right to point out the important requirement for GPs and their patients to be consulted properly about the central Government proposals.
	My hon. Friend was right, again, to point out the benefits of consultation when Governments listen to what local people want. He gave a direct example of how that had benefited his constituents in Peterborough. My hon. Friend was correct to put on the record the significant inward economic migration, which has affected his constituency and mine and put great stress on public sector services in Peterborough and Boston.
	In the time that remains, I want to highlight some of the key issues. I turn first to the GP contract. We should not allow the Government to get away with the view that GPs are somehow responsible for the reduction in out-of-hours and extended hours provision. That reduction was the direct result of the GP contract that was imposed by the Government and effectively led to reduced patient access. Furthermore, the cost of out-of-hours provision has increased by two or three times because the Government have insisted that it should be provided by primary care trusts rather than general practitioners. That has led to announcements, even last week, of cuts in out-of-hours services by contractors to primary care trusts.
	The subsequent Government reversal, as they attempted to reinstate what they were responsible for withdrawing, has shattered the relationship between the Government and GPs, resulting in GPs being very upset. In a poll, 98 per cent. of them said that they thought that the Government's methods of negotiation were unacceptable and 97 per cent. said that they had no confidence in the Government's handling of the national health service.
	All that is not the responsibility of the current Secretary of State. However, he has exacerbated the problems through his Department's tactics. The Government seriously miscalculated the number of points that GPs would earn. They rewarded GPs for a level of activity that was already in place, and that has been a significant contributory factor in the drop in productivity, leading to an additional cost of £1.76 billion to the taxpayer.
	We Conservatives are not against polyclinics or GP health centres; in fact, when they are supported by the local community, via GPs and patients, we support them. However, we are deeply concerned about the Government's plans to impose polyclinics or GP health centres in every primary care trust. That is imposition without consultation or evidence. According to the Department of Health website, the consultation process is supposed to finish on 15 May, three weeks' time. However, in certain circumstances there has, to date, been no consultation at all.
	The House must understand that we are not talking about some minor tweak to primary care. The establishment of GP-led health centres and polyclinics will be the largest change to primary care since the establishment of the NHS 60 years ago. We have heard stories about how polyclinics and GP-led health centres will be inconvenient for some individuals. They will be suitable for some, particularly in urban areas, but there is real concern among GPs—and, more importantly, their patients—in rural communities.
	The framework for action, which was specifically about London, set out that polyclinics will be cheaper and more convenient. There are arguments against the contention that they will be more convenient, particularly in respect of rural areas. In fact, polyclinics are more expensive than traditional GP surgeries, in respect of not only infrastructure, but the occupancy costs per patient. In addition, the Government must not underestimate the importance of GPs acting as gatekeepers controlling access to expensive secondary care. We Conservatives will not coerce GPs and their patients into polyclinics against their will.
	Other mechanisms and structures could be put in place and need to be considered. For example, an innovative system is operating in the floor above the Boots store in the centre of Poole, where a consortium of GPs is providing a range of services that are proving much more accessible than those at the traditional GP practice.
	Let me ask a few brief questions. Ministers are not—or were not until the Secretary of State seemed to change the policy earlier—allowing PCTs to consider the appropriateness of a polyclinic or GP-led health centre for their area. Will the Minister confirm his view? Ministers are not insisting on consultation, ensuring consideration of the impact on patient care or basing their decisions on evidence. Ministers are not allowing PCTs to use their money instead to improve the provision of health care through existing practices. Why, for example, will they not allow PCTs to use this money to invest in community hospitals rather than GP-led health centres—the point made by my hon. Friend the Member for Beverley and Holderness (Mr. Stuart)? Why will not they allow non-spearhead PCTs to invest this money for smaller GP practices in socio-economically deprived areas, thereby reducing health inequalities? Why will they not allow this money, if desired by a primary care trust, to be invested in, for example, occupational health?
	In short, the Government have been holed below the waterline as regards any suggestion that the central command and control era is over—in fact, it is going in exactly the opposite direction under this Prime Minister. At a time when the Government are closing and downgrading rural services such as post offices, local schools and police stations, we cannot have yet another local service under threat. Local accountability, local decision making, local consultation and local needs and requirements are all being overridden by Ministers. We will change that. We will empower local GPs and patients to reflect local communities' needs and requirements, driven by quality of service and by patient outcomes. Our plans will drive improvement in the provision of health care and deliver a better, more effective, more efficient and patient-focused national health service.

Ben Bradshaw: I will not, because I have only a few minutes to respond. The Opposition Front-Bench spokesman took rather longer than I was expecting.
	Those health centres will allow any member of the public to pre-book or simply to walk in and be seen by a GP from 8 am to 8 pm every day of the week. They will all have a strong focus on promoting health, particularly to hard-to-reach groups, and on preventing health inequalities. When we talk about developing health centres or when some local parts of the health service describe plans for polyclinics, we are not referring to a single, fixed model of care. These terms describe flexible models for bringing primary care together with a range of other services, be they diagnostic services, specialist care for patients with long-term conditions such as diabetes, or social care. Research shows that the public want services that are more joined up, and it shows that more integrated care produces better health outcomes. But there is no one-size-fits-all solution. What matters is doctors, nurses and other clinicians working with the public to design integrated care to meet local circumstances. That is why the Government are providing investment for the new health centres, and why we have given the local NHS the flexibility to design the services that will be based in those centres.
	Although we are not prescribing specifications for the new services—it will be up to SHAs and PCTs to design those with local communities—we are saying that there needs to be a small number of core requirements, which are expected by the public. For GP practices in under-doctored areas, those requirements include extended opening hours, engagement in practice-based commissioning and wide practice boundaries to secure the maximum level of access. For the health centres in every primary care trust area, those include: an easily accessible location; being open from 8 in the morning until 8 in the evening, seven days a week; bookable GP appointments and walk-in services; services for registered and non-registered patients; and a maximisation of the opportunities to integrate and co-locate with other community-based services.
	To respond to question put by the hon. Member for Wyre Forest (Dr. Taylor) about the role of the independent sector, even if every one of the new health centres and all of the extra capacity that we are creating in the NHS at primary care level were won by the independent sector—and that is not what is happening—the proportion of provision of primary care run by the independent sector would amount to only 3 per cent. of the national total. I would add that existing GPs are private contractors.
	It was suggested by a number of Conservative Members that the public were not interested in more flexible opening hours for GPs. They claimed that there was no demand for them. I have to tell them that every single poll—not just those done by the Department, but those carried out recently by MORI and by Which—shows that it is a priority for the public. When record investment is going into GP services, they do not consider it unreasonable to be able to visit a GP at a time that is more convenient for them.
	The proposals are also popular in rural areas. Dr. Michael Dixon, the chairman of the NHS Alliance, will be well known to many in this House, and he said recently:
	"I know that many GPs and others have difficulty with the word 'polyclinic'...but the concept of bringing practices together and providing a greater range of integrated services in the community has to be right...It might be true that small is beautiful, but professional isolation and poorly integrated services are not...Practices need increasingly to work with each other and with other partners in primary care, whether as virtual partners or on one site".
	Dr. Dixon, whom I visited with the Secretary of State last week, practises not in inner London or inner Manchester but in rural Devon. His fantastic health centre in Cullompton, far from making it harder for local people to access services, means that many people in the surrounding villages and Cullompton no longer have to travel to Tiverton or further afield to Exeter for treatment. Instead, they can receive them on their doorstep, in their local market town. Moreover, his surgery is about to embrace evening and Saturday morning opening.
	When one looks at the London model, one finds that 29 out of the 31 primary care trusts in London are already working on proposals—bottom-up, not top-down—for health centres in their areas. A recent survey by the British Medical Association, no less, found that 70 per cent. of GPs in London said that their premises were "inadequate".

David Ruffley: I beg to move,
	That this House supports the dedication of police officers in the City of London Police, the Metropolitan Police Service and the British Transport Police but notes the unacceptable trend in teenage murders in London, including the shocking figure of 27 murdered in 2007; believes that Londoners' daily experience of crime, particularly lower level crime and anti-social behaviour, is now far removed from some official statistics; is deeply concerned that violent crime in London as measured by the British Crime Survey is the highest of all the regions in England and Wales and that fear of crime in London is now also the highest of all the regions in England and Wales; further notes the link between gun crime and drugs; further believes that local communities should be given greater freedom to direct the efforts of their police force if streets are to be made safer; and condemns the current Mayor of London for his complacent attitude to these serious crime issues.
	London is the greatest city on earth. It is protected by the dedicated officers of the Metropolitan Police Service, the City of London police and the British Transport police, whom I have had the privilege of visiting during most of today. But it is also the city where the British Home Secretary, on her own admission, does not feel safe walking alone at night, and it is the city where 27 teenagers were murdered by other teenagers in 2007. Last month, a Labour Back Bencher, the hon. Member for Islington, South and Finsbury (Emily Thornberry), said "I suspect that hardly any children in Islington have not been mugged at some stage."
	London is the city where more teenagers are being mugged each year. The Metropolitan Police Service figures—not the Home Office departmental figures—show that the number of 11-to-22-year-olds reported to have been mugged in London rose from 19,276 in 2004-05 to 24,701 in 2006-07, an increase of 28 per cent. In Lewisham alone, 454 more muggings were recorded over the same period, an increase of 88.5 per cent. The Minister should note that those are Metropolitan Police Service figures.
	According to the British crime survey, London has the highest level of violent crime among all the regions in England and Wales, and also the highest level of fear of crime. Londoners are twice as likely to be robbed as people in New York city. Violent crime has increased over eight years, according to official measurements of total violent crime and to measurements of violence against the person. The respective increases have been 15.3 per cent. and over 15 per cent. Those are the Mayor's own figures. Robbery has increased by just under 20 per cent. in eight years. In 2007-08 there were more than 37,000 incidents of robbery in London. Those too are the Mayor's own figures. The number of sexual offences was greater in 2007 than in 1999-2000, according to Metropolitan Police Service figures.

David Ruffley: The hon. Gentleman has made half of a good point, in the sense that there is confusion and a bit of argy-bargy about statistics. However, he should have listened carefully to what I was quoting, because he would have realised that the British crime survey and the Metropolitan Police Service are pretty objective sources of data, which the Labour party choose to ignore when it suits them.

David Ruffley: I am grateful, Madam Deputy Speaker.
	Solutions are surely what we should be talking about. They also represent a huge divide between the proposals of that lot on the Benches opposite and the constructive, well-thought-through and well-funded proposals of the Conservative opposition in London and in the House of Commons.
	Sir Ian Blair is right to identify the amount of paperwork as a problem for the police. How can we make some kind of dent in it? The Metropolitan Police Authority has talked endlessly about cutting the number of forms that need to be filled in, but it has never got around to doing anything about it. It is nonsense to say that it is not the MPA's responsibility, but the Minister for Security, Counter-Terrorism, Crime and Policing could have done much more in that regard. Moreover, any go-getting and serious Mayor who cares about law and order could play a key role in getting police chiefs to cut the amount of paperwork that police have to complete. It can be done.
	The Government have been havering about one particular proposal that has been made, but we have stated clearly and unambiguously that we will abolish the stop-and-account form. No ifs, buts, maybes or promises of a review: we will cut it. In the Met area last year, 384,115 people were stopped, and the form involved is a foot long. Estimates vary, but it can take as long as 25 minutes to fill it in. On that basis, we believe that more than 160,000 police hours were taken up last year by the need to fill in a form that we will abolish when we come into power.

David Ruffley: I direct the hon. Lady to the review by Sir Ronnie Flanagan that was published in the first week of February. I am sure that she has heard of it, but she should try to read it as well. In it, he talks in detail about the length of the form and how long it takes to fill it in. I agree with Sir Ronnie who, being a police officer and the chief of Her Majesty's inspectorate of constabulary, knows a bit more about these matters than anyone in this building. If she has a problem with the form, I suggest that she take it up with him.
	A Conservative Government will get rid of the stop-and-account form, but we also believe that the stop and search procedure needs serious reform. An officer who stops and searches a member of the public will still need to record what we acknowledge will always be an intrusive procedure. However, not enough has been done by the Met or Ministers to put in a place a system whereby the essential details of a search are radioed in to a police log at a call centre, where they could be taped.
	Using that method, stop and searches would still be recorded, but in a paperless way. That would save time and bureaucracy and, under our proposal, a person unhappy about the circumstances of a search would still be entitled to visit a police station and request the information held about it. What could be easier than that? All that it requires is a bit of the political will so sadly lacking in the Labour party and in the London Mayor who, I believe, has held office for far too long.
	With their new laws, targets and forms, this Labour Government have presided over piles of paperwork, both locally and nationally. The Minister repeatedly claims that 9,000 forms have been cut nationally, yet—amazingly!—he refuses to publish the list. If his officials have counted that many forms, he must surely have such a list in his possession. Will he publish it today? I bet that the answer is no.

Graham Stuart: It is not surprising that the Mayor is not in sympathy with the naturally law-abiding citizens of London because in earlier years he preferred to spend time with Sinn Fein rather than with Ulster's police force. London people were prepared to forgive him that and give him a chance, they hoped that he had changed; but as he has shown that currently he prefers the company of homophobic, hate-filled extremists to that of people interested in community safety we can see why his character is not suitable to be Mayor of the city.

Keith Vaz: Has the hon. Gentleman had the opportunity to see the evidence given to the Select Committee in our inquiry on the surveillance society? He is right. There is a demand for more cameras, but there are additional costs in viewing the footage. It is not just a matter of installing the cameras and making sure that the footage is viewed live. The resources are needed to enable people to look at that footage before they make the decision to prosecute.

Andrew Dismore: To square the circle, the hon. Member for Henley (Mr. Johnson) was hardly here the last time we debated policing in London—nor was he here for the housing debate that we had immediately before this one. I want to put to my right hon. Friend the point that I wanted to put to the hon. Member for Bury St. Edmunds (Mr. Ruffley). My right hon. Friend talked about the safer neighbourhood teams; does he also welcome the safer transport teams?
	In Barnet, we have a team of 22 officers and police community support officers. My borough commander has praised it as being effective in combating crime, providing reassurance and collecting intelligence. Will my right hon. Friend condemn Brian Coleman, the Greater London assembly member for Barnet and Camden, who described the new team as a gimmick when it was introduced? How does that square with what the Conservative party says about safer transport teams? It now says that they are a good thing.

Tony McNulty: Yes we are, as Ronnie Flanagan said in his report and, I hope, as we will say in some depth in the forthcoming policing Green Paper in the spring. I take some of the hon. Gentleman's point to heart. More and more of our policing teams need to be out on the front line, and increasingly they are. We have heard a rather bogus slicing of figures this way and that by the hon. Member for Bury St. Edmunds, who used them rather obtusely instead of just using the figures themselves. I do, however, accept the starting premise of the hon. Member for Bexleyheath and Crayford (Mr. Evennett).
	The absolute key has been getting neighbourhood policing teams in place in every ward in London. By any token, that is an astonishing feat in the defence of law and order. It is to the great credit of the Mayor and the leadership of the Metropolitan police, and it should not be traduced lightly by Johnny-come-latelies of any description, whether they can be bothered to attend these debates or not.
	By the bye, Conservatives' debates on crime in London are rather Olympian in nature. I have checked, and this is the third Opposition day debate on crime in London that they have managed during my 10 years in the House. They come along every four years. We had one in 2000, just before the mayoral election, I understand—the hon. Member for North Southwark and Bermondsey will know far better than I. There was one in 2004, after the election, and we are having one now. We are pleased that momentarily, perhaps every four years, the Opposition show some concern about crime in London. I do not decry that, but perhaps it might be helpful if they did so a bit more often.
	We broadly agree with the other points made by the hon. Member for Bury St. Edmunds about sorting out crime in London, largely because many of them are being dealt with already. We have already made sure that the Met and other police services are moving towards ensuring that local crime information is provided so that communities can hold basic command unit commanders to account. There might not yet be a pretty little map, but if the extent of the contribution of the hon. Member for Henley to policing in London is that there should be a pretty little crime map as well as the information, God bless him.
	With regard to substance, it is quite right that more and more is being done on our transport network and in our town centres. In many areas, councils working with the police are doubling—and more—the number of safer neighbourhood teams in specific town centres. That is all built on a good record that stands up to any sort of scrutiny. It is not sufficient and does no one credit to dismiss measures as gimmicks when they are introduced, yet now say they are the best things since sliced bread.
	The Mayor of London has made it clear for some years that he wants the formula under the Proceeds of Crime Act 2002 to be recalibrated so that more goes to the Metropolitan police and local policing services, rather than to the judiciary, the prosecution or the Home Office. My right hon. Friend the Home Secretary said that she was minded to consider that, especially in the context of drug seizures, and to ensure that it happened. At the time—barely weeks ago—the right hon. Member for Haltemprice and Howden (David Davis) dismissed it as a gimmick, yet the hon. Member for Henley now apparently thinks that it is a good idea. Perhaps if the two connected now and again, we could get some consensus and have a proper debate about how that would help London.
	An enormous amount of work has been done, although is not enough—God knows enough tragedies happen that show that it is not enough. However, the tackling guns and gangs action programme has done much work, which led to Operation Kartel. Action took place during the February half-term in 11 boroughs, supported by TGGAT, which led to a 50 per cent. reduction in gun-enabled crime compared with the same period in 2007; a 26 per cent. reduction in knife-enabled crimes; 542 fewer personal robbery offences, and the seizure of 170 weapons, a good deal of cash and a kilo of cannabis. We are already considering purchasing 200 hand-held search wands for several operations targeting those who carry weapons. Those measures are not panaceas. Taken together, they will help to drive down crime and liberate our communities from its impact.
	We are considering establishing a mediation service to prevent gun feuds from escalating. We are working with colleagues from the Department for Children, Schools and Families to try to ensure that the youth action plan and our tackling violent crime action plan knit together the contributions from a range of central and local authorities. No doubt that will be helped by the Mayor's plans to bring a further 1,000 officers into the Met and by working with London's communities to listen to and tackle their concerns, not least through the neighbourhood policing teams, which matter, as I think everyone would agree.
	In London, the security and safety of all our communities is our No. 1 priority and I contend that it is the No. 1 priority of the Mayor of London.

Bob Neill: The hon. Gentleman has made an interesting point about safer neighbourhood teams. Perhaps he will be interested to learn that one of the teams in my borough, although it does excellent work, needs a safer neighbourhood base to patrol from. The Metropolitan police acquired suitable premises about six months ago and has been paying rent and rates on them ever since, but the premises remain empty because the bureaucrats at Scotland Yard made a muck-up of the procurement process and had to restart it. That money has therefore been wasted and the team does not have a base. Is not that a strong argument for a much more direct political drive and direction of the Metropolitan police service, as is being proposed by my hon. Friend the Member for Henley (Mr. Johnson)?

Tom Brake: I thank the hon. Gentleman for his intervention. I am afraid, however, that it is not really appropriate for me to respond to a point about what a future Conservative Mayor—if, indeed, there ever is one—intends to do with funding. The hon. Gentleman has, however, reminded me that the Home Office needs to address one particular aspect of tackling gun and knife crime—the research carried out into the effectiveness of different projects. The range of projects currently run from perhaps a single ex-offender who has taken it on his or herself to organise something at a very local level through to much larger funded projects. On the basis of a conversation with a member of the Metropolitan Police Authority, I know that not much research has been done into which of those projects really deliver and which deliver value for money. I hope that when the Minister responds, he will be able to say a little about what research the Home Office is either carrying out now without my knowledge, or intends to carry out to assess which projects deliver the best value in tackling this very serious problem.

Clive Efford: Thank you for correcting me, Mr. Deputy Speaker. I am using the colleagues of the hon. Member for Putney (Justine Greening) to highlight the fact that they do not agree with the arguments being put by Conservative Benchers.
	Hillingdon council boasts that
	"crime figures are at a 5-year low. Personal robbery is at its lowest for 3 years, vehicle crime is at its lowest for 5 years and assaults are at their lowest for 5 years."

Justine Greening: On a point of order, Mr. Deputy Speaker. I have been trying to intervene to set the record straight. Can you give me some guidance on whether it is appropriate to read quote from, for example, Hammersmith and Fulham council but to omit to mention that the council has funded additional police officers and could have been talking about that fact?

Clive Efford: I am slightly confused, as I used the words of the Conservative-run Wandsworth council—"despite recorded crime falling". What is erroneous about that? Is the hon. Lady saying that the information on the council's website is erroneous? Does Wandsworth council want to mislead people about crime falling in the area? Is it wrong for it to claim that the incidence of burglary is at its lowest for decades?
	The council states that research shows that a third of people believe that crime has risen, and that is consistent with the point made by the hon. Member for Putney, but it also says that the safer neighbourhoods teams will provide reassurance. Where is the consistency in the Opposition approach to these matters?

Clive Efford: I am grateful to my hon. Friend, who illustrates the fact that there is more to recruiting police officers, and to the cost of doing so, than just paying for them. The infrastructure has to be put in place to get qualified police officers.
	It is a shame that the hon. Member for Bury St. Edmunds (Mr. Ruffley) is not in the Chamber, because if he were he could intervene on me and clarify exactly what he was on about. He said that he wanted to get rid of stop and account forms. I hope that I did not hear my hon. Friend the Minister incorrectly, because I would find it extraordinary if we were to get rid of the forms completely. I went to see my borough commander and local inspector to talk about the forms and how we could get our safer neighbourhood teams and police officers out on the street, rather than having to spend too much time on bureaucracy. They sent downstairs to have the form brought up and we went through it. I said, "Wouldn't you want to get rid of this form?" He said, "No, absolutely no way. This form provides us with a lot of intelligence. If we stop someone, take a brief description of them and later on find that a crime was committed by someone who fits their description, we have a record that we can follow up." That approach has led to the clearing up of a lot of crime in local communities. The idea that the forms are a waste of time and resources is completely bogus. It is not accurate at all.
	The hon. Gentleman said that the Conservatives would spend money on hand-held scanners, so will the police stop people in the street, scan them with no explanation, keep no record of who has been stopped and why and let them go on their merry way? When there is an incident the police will have no record of who has been stopped. If somebody wants to check why they were stopped and make a formal complaint there will be no formal record of what has taken place. It does not make sense. It does not add up. The Conservatives say that they want to get rid of bureaucracy and to make the police more effective, but they would take away a tool that is essential for the operational efficiency of the police. They claim that they want to make the police more accountable, but they would take away the form that allows an individual to check why they were stopped and what intelligence was gathered about them.

Clive Efford: I agree absolutely. People from all sections of our communities need confidence in their police force. Stop and search was one of the things that undermined not only the relationship between police and local communities but police efficiency. To go back to it would be a retrograde step.
	As the Member of Parliament for Eltham, I paid close attention to the issues brought out by the Macpherson report. One of the factors that came out loud and clear from members of ethnic minority communities was that they wanted better and more police accountability. Woe betide anybody who wants to go back on that in the future.
	My local authority wants to deal with the rise in crime among young people, which is clearly a problem. Young people are the victims of crime committed by young people and everyone is rightly concerned about that. My local authority will invest £1 million in setting up a taskforce to tackle the problem in partnership with the local police, but local Conservative councillors oppose the plan even though it is a priority for the whole community. If we ask people what concerns them most about crime in their community we realise that it is not necessarily fear of being a victim of crime; they are actually concerned about young people.
	We are attempting to deal with the problem. Young people have been murdered in Greenwich and the council is responding, but the Conservative response to that attempt to work in partnership with the police is to oppose the £1 million investment and say that the Mayor should pay for the taskforce. That is okay, but I cannot see £1 million for tackling those crimes in Greenwich in the Conservative mayoral candidate's budget for London—I cannot see it anywhere. Again, there is inconsistency and local opportunism from the Conservatives.
	My final point is about leadership. We have talked about stop and search and the confidence of ethnic minority communities. It is essential for police operations that the police have the confidence of all sections of our community. If the Mayor is to be the chair of the Metropolitan police authority, as the hon. Member for Henley tells us, he will be at the forefront, encouraging people from all sections of the community, including ethnic minority communities, to join the police force. If he attends a parade at Hendon police training college, will he expect the qualified police officers who are turning out to celebrate him, their having been called "flag-waving picaninnies"? Would he expect any black police officers to smile at him— [Interruption.]

James Brokenshire: It is a pleasure to follow my hon. Friend the Member for Bromley and Chislehurst (Robert Neill), who made an important point in his comparison of London and New York.
	I join other hon. Members in paying tribute to the work of all police officers in the capital in their daily fight against crime. The Metropolitan police, the City of London police and the British Transport police all work hard on our behalf to secure the protection of everyone who lives and works in the capital. It is right that we should recognise their service, commitment and dedication to duty. But the inescapable fact highlighted by the debate is that the Labour Mayor and the Labour Government are letting London down on crime. Violence against the person is up, with over 3,300 crimes committed each week. Drug offences, with their links to organised crime and gang violence, have increased by an astonishing 200 per cent. since the Mayor came to office, and nearly half of Londoners say that they simply do not feel safe in their communities at night. If that is a measure of success it shows just how out of touch the Government and the Mayor are with reality and with real Londoners.
	The hon. Member for Carshalton and Wallington (Tom Brake) made some important points about gun and knife crime and the serious issues that arise from it. The hon. Member for Regent's Park and Kensington, North (Ms Buck) brought those issues home in her description of the tragic deaths of her constituents. I am sure that the whole House wishes to pass on its condolences to the families of those involved in those terrible incidents. The hon. Member for Eltham (Clive Efford) sounded at times as if he were reading from the telephone directory, rather than reading a speech. Instead of lecturing my party about the stop and account form, he should look at the Flanagan review, commissioned by his own Government, which recommended that the form be abolished.
	My hon. Friend the Member for Ilford, North (Mr. Scott) made some important points about the way in which local initiatives can make a difference, and about how, in Redbridge, locally funded street wardens are helping to deal with antisocial behaviour in his constituency. That point about local community action and how it can make a difference was also raised by my hon. Friend the Member for Putney (Justine Greening).
	Sadly, I have to say to the hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) that he does himself no favours by making personal smear attacks. There are very serious issues to be debated, and rather than this party being confused or being in denial on those issues, I suggest that his criticisms should be directed to his party and the Mayor.
	Many hon. Members have highlighted the shocking number of teenagers killed on London's streets in the last year: 27 teenagers were murdered, with 11 murders of young people in 2008 already. One of the most disturbing trends is that both the victims of these crimes and those suspected of carrying out the offences are getting younger. Analysis from Trident has shown that in certain cases the age of those involved is as low as 14, with more teenagers being charged for murders and shootings. I have spoken previously about the organised gang culture, supported by the trade in class A drugs, that lies behind a significant proportion of these crimes.
	One of the most insidious aspects of the organised criminal gang structure is the conscious focus of those who recruit new gang members on some of the most vulnerable in society—those with poor educational attainment and weak family support structures, and those who suffer from addiction, mental illness and unemployment. They are targeted to deal drugs to give them an income. That is why the utter failure to control drug crime in the capital is so serious and why simply giving out more cautions for drug offences—with the number doubling in the past two years—sends out the wrong message.
	Other fundamentally wrong messages are being conveyed. I stress to the Minister in the starkest terms that police trying to negotiate with the gangs, as some recent statements from the Metropolitan police suggest, is not the solution. We need strengthened communities and families, and visible and robust policing. We also need to tackle the underlying problems of addiction.
	The Government have opted simply to maintain addiction rather than lift people out of it, with London's bill for methadone prescriptions running at £2.5 million a year.
	We need proper, abstinence-based rehabilitation for offenders, not a slap on the wrist and a prescription for the pharmacist. The police also need effective tools—that is why we believe that it is right to revise the current powers of stop and search to give police sergeants, who are at the heart of safer neighbourhood teams in their communities, the right to authorise general stops and searches in a designated area, where weapons are thought to be present or crimes of violence are thought to be about to occur, for a period of up to six hours.
	However, the problem is not only the most serious offences, but the everyday experiences of Londoners on their streets, in their communities and even in their homes.
	For too many, the impact of antisocial behaviour and what some describe as "low level" crime is significant. There is nothing low level about the impact of antisocial behaviour on people's quality of life. For many, especially the elderly or vulnerable, their street, shops or neighbourhoods do not feel safe. That picture is reflected in the opinion surveys of London residents and hardly alleviated by the comments of the Home Secretary or the actions of the Leader of the House.
	However, young people are more likely to feel the effects of antisocial behaviour and crime. Around a third of all street robberies are committed against the under-16s. Some Labour Members have rightly highlighted the number of young people who are mugged in London. It is absurd that the Government continue to drag their feet in recognising crimes against the under-16s in the British crime survey. As we have heard, such offences often occur on the buses, the tube and other forms of public transport, with mobile phones, iPods and other valuables being stolen.
	My hon. Friend the Member for Henley (Mr. Johnson) rightly identified a more visible police presence, the use of real-time CCTV and tougher measures to tackle fare evasion and the abuse of the transport system as important measures to restore public confidence.
	The Government have completely lost their way in cracking down on antisocial behaviour. Their rigid, centralised, bureaucratic command and control structures have driven the police in the wrong direction, chasing meaningless targets for "bringing crimes to justice", involving issuing penalty notices like glorified parking tickets. In 2006, nearly 21,000 penalty notices were issued in the capital—yet only four out of 10 were paid in full. It is difficult to identify the "justice" in that.
	Even the Metropolitan Police Commissioner, Sir Ian Blair, has hit out at the system that has grown up around him. Yet neither the Government nor the Mayor have acted on that. So much for the bonfire of the regulations, for which the Metropolitan Police Commissioner called. That is why my hon. Friend the Member for Henley is absolutely right to identify the need to scrap the unnecessary stop form, freeing around 160,000 hours, which the police could spend on the beat, protecting Londoners and catching criminals.
	The Government's supposed measures to improve community safety have made things worse, not better. London's A and E departments are feeling the strain from the impact of the Government's 24-hour drinking laws. Since the introduction of those changes, London hospital casualty admissions for alcohol-related problems have increased by a third. That highlights how cavalierly the Government introduced 24-hour licensing. But since 2000 the police precept has increased by around £400 million—an increase for the taxpayer of 150 per cent. per person. That is why we need to give Londoners proper details of police performance in their areas, through effective crime mapping in their neighbourhoods. That way, communities can play a more active part in holding the police to account.
	The real question, however, is how committed the Government are to neighbourhood policing. As we have heard, the Flanagan review states that the current police numbers are "unsustainable". The Government have welcomed the report, so presumably they welcome the cuts in police numbers that it underlines. The clear message is that police numbers are at risk. Violent crime in London is up, while drug crime has rocketed under Labour. Londoners deserve better than the tired offerings of a tired Mayor and a tired Government. It is time for a change. It is time for concerted action to make this city a safer place. It is time for a Conservative Mayor of London.

Vernon Coaker: My right hon. Friend puts the issue well. Let me read out some facts, so that we can get them on the record. Police numbers in London are at record levels. Since 2000, there has been an increase of more than 10,000, which has been made possible by the Government's and the Mayor of London's investment. The figure of 35,000 is made up of more than 31,000 police officers and more than 4,000 PCSOs. The Mayor's budget for 2008-09 includes an additional 1,000 police officers. Let me also put it on the record that those are the figures from the Metropolitan Police Service. They are the figures that the Opposition seemed to traduce, when they said that there were not real figures or figures to be trusted. I will tell you what, Mr. Deputy Speaker, if I am going to trust any figures, I am going to trust the Metropolitan Police Service's figures on recorded crime.
	It was interesting that the hon. Member for Bury St. Edmunds (Mr. Ruffley) would not go back to 2002-03, but used 1998-99 as his baseline. The reason is that there was a different way of counting crime in 1998-99. Let me go through the figures, just as the Metropolitan Police Service has, from 2002-03 to this year, which are all counted in exactly the same way, so that the people of London know exactly what is happening. Between 2002-03 and this year, there was a more than 20 per cent. reduction in crime. There has been a reduction in the total number of murders in London since 2002-03 of 17.5 per cent, and a reduction in the total number of knife-enabled offences of more than 30 per cent. during that period. The year-on-year figures from the Metropolitan Police Service also show considerable reductions in crime. We need to ensure that the people of London know about these reductions, not because we want to be complacent or because the job is done, but because we want to move forward on the basis of facts.
	My hon. Friend the Member for Eltham took great delight in reading out what Tory-controlled authorities in London were saying about crime in their local newsletters and on their websites, and I do not blame him for doing so. What they are saying is totally at odds with what those on the Opposition Front Bench have suggested. Let me defend some of those Tory borough councils in London for what they have said about crime. Tory-controlled Barnet council says that it has seen a 17.5 per cent. reduction in crime, while Enfield council's website states:
	"The number of offences in Enfield has fallen by nearly 10 per cent."
	Many other Tory-controlled authorities right across the city are congratulating themselves on falls in crime and telling their residents about them. That is completely at odds with the picture that the Tory mayoral candidate and the Opposition Front Bench spokespeople are trying to paint.
	Why have we seen this reduction in crime? Why have we seen such an increase in confidence among people in London in this regard? It is partly a result of the introduction of the safer neighbourhood teams, which were introduced with the wholehearted support of the Mayor. Indeed, with his support, they were introduced a year earlier in London than in much of the rest of the country. We now have visible, accessible, responsive policing on our streets in all 600 wards in London. Let us also be clear that a key part of the safer neighbourhood teams in each and every ward is played by the police community support officers, whose introduction was opposed by the Conservatives, including the hon. Member for Henley.
	Alongside the safer neighbourhood teams, we need to see tough enforcement of the law, and we have indeed seen special police operations taking place alongside the work of the teams. Let us also remember that tough enforcement of the law includes tough sentencing. One of the toughest sentences that the people of London support is the minimum sentence for the possession of unauthorised firearms, which was also opposed by the hon. Member for Henley.
	While we are talking about the need for tough enforcement, let us also reflect on what contributes to the reduction in crime, and on what makes a difference. Alongside the tough enforcement approach and the safer neighbourhood teams comes partnership and prevention. If we are to continue to reduce crime and to tackle gun and knife crime, we also need to invest in youth services and the partnerships involved in them. The Mayor of London has led the way in supporting initiatives across the city to prevent young people in particular from becoming involved in crime. He has been particularly involved in trying to divert young people away from crime in the first place. With the Government, he has set up a new £75 million youth offer, which will make a considerable difference in tackling these issues in our communities across London. It will give support to the parents and young people who need it, and it will develop the services that are so important if we are to continue to bear down on—

Motion made,
	That this House concurs with the Lords Message of 20th March, that it is expedient that a Joint Committee of Lords and Commons be appointed to consider and report on any draft Constitutional Renewal Bill presented to both Houses.
	That a Select Committee of eleven Members be appointed to join with the Committee appointed by the Lords to consider the draft Constitutional Renewal Bill (Cm. 7342).
	That the Committee should report on the draft Bill by 17th July 2008.
	That the Committee shall have power—
	(i) to send for persons, papers and records;
	(ii) to sit notwithstanding any adjournment of the House;
	(iii) to report from time to time;
	(iv) to appoint specialist advisers; and
	(v) to adjourn from place to place within the United Kingdom.
	That Mr Alistair Carmichael, Mr Geoffrey Cox, Michael Jabez Foster, Mark Lazarowicz, Martin Linton, Ian Lucas, Fiona Mactaggart, Mr Virendra Sharma, Emily Thornberry, Mr Andrew Tyrie and Sir George Young be members of the Committee.— [Liz Blackman.]

John Hemming: I should like to thank Mr. Speaker for agreeing to the subject of this Adjournment debate.
	I should start by declaring that in 2006 I brought together a number of campaign groups in the justice for families campaign, which I chair. I am also taking the unusual step of releasing a campaign song, the proceeds of which will be used to prevent miscarriages of justice.
	There is something rather dreadful happening in England today, but not in Scotland. In England, we have targets for adoption and rewards for moving children from one family to another, but not in Scotland, where the priority is to keep families together. In England, two thirds of children leaving care are adopted, but not in Scotland, where two thirds of children under five go home to their birth parents. The drive to increase the number of adoptions and the recycling rewards for local authorities have caused masses of miscarriages of justice. Yvonne Coulter, Chris Smith, PC and S and the Websters were all cases in which children were stolen by the state from their birth parents, only for it to be found later that it was a mistake. A mistake, yes, but not a mistake that can be put right.
	I know of a case in which a baby was put into care on a fast track to adoption because his mother might get post-natal depression. Is that right? I do not think so. How did it help the local authority? It helped it hit its recycling target. In the deep, dark corners of the British legal system, hidden away by threats of imprisonment for those who speak out about injustice, we have allowed bad practice to fester. No action can be taken by a Member of Parliament to prevent solicitors from undermining their own clients because they want to keep the money coming in from the local council. No action can be taken by an MP to stop social workers who lie to the courts because they want to win a case and hit their adoption targets, or to stop doctors who provide rubbishy, unproven and unchallenged medical evidence that destroys families, but fills their bank accounts.
	The reason for that is the secrecy of the proceedings under the Access to Justice Act. There are a number of very good people working in the system to protect children from maltreatment, but they are undermined by the lack of action to deal with bad behaviour by practitioners. That has to come to an end. We need to consider the issues honestly and openly while we have an opportunity to amend the Children and Young Persons Bill. I have two new clauses that could assist in improving accountability without undermining children.
	As in all aspects of the public or private sector, there is a range of people of different competences. There are some very good people working as social workers, lawyers, experts or judges, but there are also those who are incompetent or corrupt. The difference in public family law is that the secrecy of the system prevents accountability. In theory, there are checks and balances that prevent the abuse of state power, but practitioners often collude to prevent those checks and balances from coming into operation.
	A good current example is a case covered in the following verse in the song I referred to earlier:
	"The boys they say that they won't talk to their mom
	The judge says foster care is what must be done
	Dad says its wrong by writing a book
	He's put in jail 'cos somebody looked."
	It is absolutely absurd to place two children aged 13 and 15 in foster care because they will not talk to their mother, who is estranged from their father. The father would like to appeal, but the lawyers, including his own solicitor, are working against him. To appeal, he needs a judgment, but he still has not been given it. On Monday, I spoke to the 15-year-old, who is in fact 16 today, and he said, "I think children's social services are a complete disaster. My brother is mortified because he wants to go back to his dad. I think the way things are happening is pathetic. My father has never hurt either of us."
	Let us understand the reality of this. Tens of thousands of pounds are being spent to keep in care two children who have never been hurt by their father. In effect, they are being imprisoned in care for no good reason. However, outside Parliament, we are not allowed to scrutinise the reasoning. The problem is that the rule of law is systematically undermined in the family division.
	There is supposed to be a tape recording of the hearing. However, as yet, we have not managed to obtain a copy of such tapes. Transcripts are refused to parties on the basis of exaggerated costs. In the Harkness case, the transcript did not correlate with the parents' memory of the case. In Pauline Goodwin's case, the tape of her hearing in the Court of Appeal seems to have gone astray. If somebody manages to get a case to the Court of Appeal, the court has been known to say that it is out of time even though somebody has been struggling for years for a judgment.
	One of the more worrying aspects about the Court of Appeal is that substantive cases are heard at the permission stage. If the court decides to refuse the appeal, it makes an order under section 54(4) of the Access to Justice Act 1999, preventing the case from going to the House of Lords. The Act prevents family law decisions from being considered by the House of Lords to ensure that we have a unified body of law. We have to ensure that parties are provided with tapes of their hearings immediately afterwards so that they can obtain timely copies of the judgments. We also need to change section 54(4) of the 1999 Act so that there is proper consideration of issues by the UK Supreme Court, the House of Lords.
	It is worth considering a few cases in some detail to see how things go wrong. Fran Lyon's case never encountered the courts. She was a pregnant mother who became one of my constituents for a while before she emigrated. She was told that she was such a great risk to her baby that the child had to be removed within 15 minutes of birth and she could never breast-feed. However, her case was reviewed in Sweden. All the information cooked up by children's services and doctors in Northumberland was examined and it was decided to discharge her from hospital. Fran suffers from angiodaema so she has a tracheotomy. The doctors in the north-east said she had Munchhausen syndrome by proxy and caused her angiodaema herself. The doctors in Sweden said that she should sue the doctors in the north-east for malpractice because her angiodaema was not self-induced—it even occurred when she was unconscious. Yesterday, I received the official English translation of the Swedish social work report, which concluded:
	"Our assessment is that there is no need for support or any other programme with regard to Fran's capacity as a parent."
	In England, the plan was to take the baby 15 minutes after birth, which would have also involved the usual twin-tracking adoption plan. In Northumberland, there was systematic and corrupt abuse of process. Sadly, that is all too common in the system.
	In Norfolk, in the Webster case, the health visitor was pressurised to change her opinion about the family. When combined with unreliable and wrong medical evidence, that caused three of the children to be adopted. Another case in Norfolk involved three social workers in a 12-person case conference deciding to override the nine-three vote that a child was not at risk. Instead, they put the child on the child protection register. All 12 experts got together. Nine voted that there was no problem, but three voted that there was and later decided to ignore the nine. That is abuse of process. It is not democratic and it is not a proper mechanism. I am aware of other sub judice cases in Norfolk, on which of course I cannot comment. They all involve abuse of process and perversion of the course of justice.
	Although the targets and financial rewards for adoptions have now rightly been scrapped, their presence has massively damaged an already creaking system. While they were in place, in law the opinion of the local authority was subject to a financial conflict of interest, which made a substantial number of judgments unlawful. The lawyers like to blame the social workers. However, the real problem lies in the court system and the law.
	The test for almost any decision making is whether there is a "risk of significant harm"—the standard section 31 definition in the Children Act 1989. The vagueness of that description allows all sorts of nonsense to be accepted. At the same time many parents' solicitors are subjected to a conflict of interest because they are also paid by the local authority or guardian. It is sadly not rare for a parent's solicitor to fail to contest an application for a care order, or indeed to persuade parents, against their will, to accept that the section 31 threshold has been met. At that point the parents are at the mercy of the state's family steamroller.
	In the meantime, the children are almost invariably ignored. I referred to the case of children who did not want to be in care; they are being ignored by their guardian. Someone is appointed whose job title is "representing the interests of the children"—the guardian ad litem. Most of those guardians work for CAFCASS—the Children and Family Court Advisory and Support Service. CAFCASS East Midlands was recently inspected by Ofsted, who found the service "inadequate"; in other words, not up to the job.
	Historically, the judges have had a tendency merely to agree with the proposals of the local authority, unless the guardian takes a different view; we therefore have a system that depends on a financially biased local authority and a frequently inadequate guardian—not a recipe for good decision making. That meant that parents did not have a prayer. Things have improved more recently, and that should soon become evident from the statistics on cases. There are still problems following the new public law outline, but most of the cases in which there are problems are still sub judice, so I shall not refer to them.
	What are the Government doing? Recently, the case of Simeon Kellman came before the criminal courts. He used a council's child database to find victims to abuse. The Government are to introduce a national database, so that the Kellmans of this world can find their victims nationally—very clever. We know that being in care is not good for children, so why are children put into care for rubbishy reasons?
	Another problem is that we really do not know what happens to children who go through the system. One local authority lost 61 children in one year; it has no idea where they have gone. There is an annual return called the SSDA903 that is sent to the Department for Children, Schools and Families. That return does not track the point at which children come out of care, unless they are adopted or go into special guardianship. It does not track most outcomes; it gives them as "other". When one asks people to go through the files, as we did in the case of the authority where 61 children were lost, they say that they can find some of the children, but one local authority—admittedly a rather large one—does not know where 61 kids went. In Scotland, authorities do look at where children end up. That is why it is easier there to find out what is happening to the children.
	We have been running a massive social experiment in forced adoption—adoption against the will of not just the parents, but those children old enough to understand what is happening. A study conducted by Ofsted looked at children's views of the adoption process. At least a third said that they did not want to be adopted; they wanted to be left where they were. Inevitably, a large number of forced adoptions break down, but there is little research on the subject. I recently had discussions with the National Society for the Prevention of Cruelty to Children about the process of forced adoption and how it affects children in the long term. Figures indicate that the failure rate of forced adoptions is, at a minimum, a quarter to a third. That is the sort of information on which we should get proper research, but that research is not being done.
	Another appalling aspect of the system is the way in which children are damaged by care proceedings, even if the proceedings end with the children going home. Let us take a situation where a baby is taken away at birth and put into foster care—that is not good for the baby, to start with. After about a year's legal wrangling, when people have made lots of money from representing various parties, the child goes home because it is found that there was no evidence of any risk in the first instance. Think about the Fran Lyon case; what would have happened to her if she had stayed in England? She would have lost her baby at birth and there would have been massive wrangling. In fact, her first lawyer told her that she should just give up because she would never win, so she emigrated. It damages children to go through that process. The fact that the system tends not to let go means that children get damaged by the process.
	A case in Oldham—the judgment was anonymous, which is very good—caused a mother to have an abortion to avoid care proceedings. In that case, a child was taken away at an early stage because of allegations that the child had been harmed by the parents. After massive legal and medical wrangling, and an attempt to get a second opinion—the opinion was initially refused by the court of first instance and by the court of appeal, but then accepted by the court of appeal—the parents were proved innocent. They were not just not guilty; it was proved that it was not a shaken-baby-syndrome-type case, for those who study these things. There was no justification for the intervention whatever, but the child and the parents suffered, and the mother had an abortion to prevent the same thing from happening to another child.
	We really need to carry out proper, rational risk analysis. The intervention of the state is almost invariably damaging. We need to minimise the damage caused by intervening while any investigation is going on. Most foster carers are good people, but we have to stop covering up situations where foster carers abuse the children in their care. The Care Leavers Association wants a public inquiry on the issue, and we should accede to its demand. We also need to revisit the idea of supporting families, rather than using the hammer.
	The system is far more badly broken than I expected it to be when I started studying it. The way in which the child protection system operates has wide ramifications for society. The evidence is clear in the number of prisoners who have been in care. It is also clear that the removal of children from mothers who are victims of domestic violence is causing them not to report that violence. The procedures followed after multi-agency risk assessment conferences, which are carried out in response to 392 forms, are causing concern among mothers who are victims. People suffer in silence rather than having to handle the consequences of asking for help.
	We cannot continue leaving the details to the practitioners. Proper scrutiny and accountability are essential. The system is supposed to have as a priority keeping families together. Why, then, are they split up in England, but kept together in Scotland? The Prime Minister said that the difference came from a difference in social work practice. Clearly, the system does not do what it says on the box. It does not protect children properly or support keeping families together properly. The evidence is there, north of the border.
	We have systematically excluded grandparents from the decision-making process. That is ludicrous, as they are the normal source of back-up child care. Early-day motion 1199, which I tabled, focuses on the issue, following suggestions from the GrandParents Association and various other lobby groups. I am pleased to say that a motion has been tabled at the Council of Europe leading towards an investigation into family law in England and Wales. It would be good if we could have such an investigation in this country and not rely on the Council of Europe to sort out our problems.
	Yesterday, we heard of the number of families destroyed by the system, often for no reason other than financial reward. Today we must start debating the issues, and tomorrow we need to reform public family law and stop such things ever happening again.

Bridget Prentice: I congratulate the hon. Member for Birmingham, Yardley (John Hemming) on securing a debate on an issue that is important to everyone in the House and outside—an issue that we should examine with care and consideration. Instead of ranting, we should take a comprehensive, considered and objective view of what we can do to make life better for those who are among the most vulnerable in our society. I am pleased, therefore, to have the opportunity to speak about the proceedings for children and to reiterate and emphasise the Government's commitment to helping and supporting vulnerable children.
	Fortunately, the number of children in need in this country is relatively low compared to the total number of children in the country, but that does not mean that we should be or are any less committed to addressing those children's problems. We take our responsibilities in that regard extremely seriously. I shall summarise the recent background to the way we deal with matters relating to children and young people. In 2003, we published the "Every Child Matters" Green Paper, which set out five outcomes that we want to see achieved for all children. It is worth remembering that one of those outcomes was that children should be protected from harm and neglect so that they stay safe.
	Things have not stood still since 2003. The Children Act 2004 put in place new structures to help us deliver those five outcomes. Also in 2004 we published "Every Child Matters: Change for Children", which set out a continuing national programme of change, outlining how the reforms were to be implemented. At the heart of that programme was the goal of ensuring that all children, especially the most vulnerable, are able to stay safe. I agree with the hon. Gentleman in one respect. Our starting point is that state intervention is and must always be a last resort. We firmly believe that children should live with their parents, provided it is safe, and that, where necessary, families should be given extra support to help them stay together.
	On 1 April this year, I made a written statement to the House detailing two key reforms to the wider care proceedings system, which came into force on that day. The first of those was the revised Children Act statutory guidance to local authorities, issued by my colleagues in the Department for Children, Schools and Families and the Welsh Executive. It underlined to local authorities the need for them to work more closely with families and others to find alternative solutions to entering legal proceedings at all, always, of course, on the basis that it is safe to do so.
	The guidance stressed that local authorities must explore all safe and suitable alternatives. Those should include targeted support for parents to enable children to remain at home and, another option that is hugely important in our diverse society, the possibility of the child being cared for within the wider family, whether by grandparents, aunts, uncles or even older siblings.
	Of course, that was already a requirement in the Children Act 1989, but it was re-emphasised, and I hope will be continually re-emphasised, under the guidance published a few weeks ago. That said, where the local authority has immediate concerns about safety, they are able to apply for an emergency protection order or to make an immediate application in care proceedings. We know—something to which the hon. Gentleman referred—that the longer-term prospects for children who remain with their extended birth family where it is established that it is safe, can be much better than for children who are in care.
	At the same time in April, a second reform, the public law outline, also came into effect. This is a new judicial case management tool that dovetails precisely with the statutory guidance. It provides a more streamlined procedure for the way in which courts handle care applications, so that cases can be resolved more rapidly when a local authority decides that the only safe solution is to seek an order through the court.
	The outline makes it clear to local authorities what the courts expect of them. Local authorities will have to demonstrate to the court that they have thoroughly explored all suitable and safe alternatives. They will also have to show the court what steps they have taken to work with families to try to enable the child to remain within his family home or within the wider family. In that way, the outline will, to all intents and purposes, provide an additional check on the actions of local authorities that issue proceedings.
	I want to share with the House some of the things that were said at the formal launch of those reforms on 1 April. I sat and listened to the three representatives of the Children and Family Court Advisory and Support Service young people's board who talked more eloquently than any politician or professional about their hopes and aspirations for the way in which the reforms will impact on their lives.
	One of them said:
	"You will be working with us as active partners in our own case...listening to us, understanding us, moving at our own pace...sometimes faster, sometimes slower."
	So I take issue with the hon. Gentleman when he says that we are not listening to what young people have to say. He will know that I have a particular interest in ensuring that young people's voices are heard in this place in terms of extending our democracy, and in terms of those who are vulnerable and who need the state's systems to protect them.
	Another of the young people said, "Sise does matter." Sise being: see us, inform us, support us, empower us. It is true that in the past it has been all to easy sometimes to forget that what we do, we do to protect children, and that children's voices can often be swamped in the adult noise. Of course the Children Act underlined that when it said that the welfare of the child must be paramount in the decisions of the court. I do believe that the Children Act strikes the right balance; a balance between the complex set of rights and responsibilities, the rights of a child to be safe from harm, and the responsibilities of parents. It also makes it clear that the state has a duty to intervene, when a child's welfare demands it.
	We have introduced the Children and Young Persons Bill, which is a key part of our agenda to improve outcomes for children in care. Our aspirations for children in care must be as high as those for our own children. We must ensure stability in every aspect of care, and there must be good parenting from all those working with children in care, in the same way as we work on improving parenting for those children who remain with their families. There must also be a stronger individual and collective voice for every child in care. The Bill will provide the legislative base to deliver many of the changes set out in the White Paper, "Care Matters: Transforming the Lives of Children and Young People in Care", to make that vision a reality.
	The hon. Gentleman has raised a number of individual cases, although he could not refer to some of them in detail. I do not believe that there is systematic corruption and unprofessionalism throughout the social services, local authorities, the courts or elsewhere. He is being unfair to those who work closely with children who need our help and support, and who ensure that those children receive that help and support. The president of the Association of Directors of Children's Services "flatly rejects" the odious claims surrounding so-called forced adoptions. There is no coherent evidence to support those claims, and the notion that honest, skilled and hard-working professionals would seek to cause children to be adopted unnecessarily is unacceptable. I believe that she holds that view honestly and professionally, and the Government and I support it. Our underlying theme will always be that the welfare of the child is paramount, which is what we seek to achieve.
	 Question put and agreed to.
	 Adjourned accordingly at eight minutes to Eight o'clock.